=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477303527
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHELE STEPANEK TEAGUE MSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2024
-----------------------------------------------------
Last Update Date | 03/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9650 COMMERCE DR STE 521
-----------------------------------------------------
City | CARMEL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46032-7639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-748-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8090 SHALDON CT
-----------------------------------------------------
City | ZIONSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46077-7980
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-748-4200
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 99122959A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------