Provider Demographics
NPI:1881582724
Name:TEELUCKSINGH, MICHALA TYANN
Entity type:Individual
Prefix:
First Name:MICHALA
Middle Name:TYANN
Last Name:TEELUCKSINGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9002 MAPLECREEK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4842
Mailing Address - Country:US
Mailing Address - Phone:502-751-4372
Mailing Address - Fax:
Practice Address - Street 1:315 TOWNEPARK CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-2338
Practice Address - Country:US
Practice Address - Phone:859-436-8439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY277352101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health