Healthcare Provider Details

I. General information

NPI: 1427667294
Provider Name (Legal Business Name): LAURA E TEEPLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20410 OBSERVATION DR
GERMANTOWN MD
20876-4000
US

IV. Provider business mailing address

9517 FINGERBOARD RD
IJAMSVILLE MD
21754-9413
US

V. Phone/Fax

Practice location:
  • Phone: 240-296-5920
  • Fax:
Mailing address:
  • Phone: 347-512-7129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: