Healthcare Provider Details

I. General information

NPI: 1821739095
Provider Name (Legal Business Name): TEDDI JOHANNSEN LCSW, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2022
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 2ND ST W
WHITEFISH MT
59937-3074
US

IV. Provider business mailing address

2330 DILLON RD
COLUMBIA FALLS MT
59912-8928
US

V. Phone/Fax

Practice location:
  • Phone: 406-298-5728
  • Fax: 406-730-2488
Mailing address:
  • Phone: 406-212-2269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-59080
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberBBH-LCSW-72298
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: