Provider Demographics
NPI:1679457832
Name:MOON, TEQUEILA CHERIE (LMSW)
Entity type:Individual
Prefix:
First Name:TEQUEILA
Middle Name:CHERIE
Last Name:MOON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 TORREY PINES LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2110
Mailing Address - Country:US
Mailing Address - Phone:615-423-5832
Mailing Address - Fax:
Practice Address - Street 1:5 TORREY PINES LN
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2110
Practice Address - Country:US
Practice Address - Phone:615-423-5832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN09861104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker