Healthcare Provider Details

I. General information

NPI: 1104411552
Provider Name (Legal Business Name): ALICIA M. TEETER MS, LPC, LCPC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 KINNER DR
GILLETTE WY
82718-6261
US

IV. Provider business mailing address

3313 KINNER DR
GILLETTE WY
82718-6261
US

V. Phone/Fax

Practice location:
  • Phone: 307-314-0437
  • Fax:
Mailing address:
  • Phone: 208-201-5237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-2075
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-2075
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2607273
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLPC-2075
License Number StateWY
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8781012
License Number StateID
# 6
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-2075
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: