Individual
TANECHI TEMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1213 MARIA LN, IUKA, MS 38852-1135
(662) 423-3332
Mailing address
1213 MARIA LN, IUKA, MS 38852-1135
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
08/07/2017
Last updated
08/07/2017
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