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General NPI Number Information
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NPI Number | 1699388769
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Entity Type | Individual
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Provider Name | JUSTIN DEAN TEETERS CDCA
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Gender | Male
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Dates
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Enumeration Date | 08/28/2020
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Last Update Date | 08/28/2020
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Provider Practice Location Address
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Address Line | 1012 ODNR MOHICAN 51
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City | PERRYSVILLE
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State | OH
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Zip | 44864-9407
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Country | US
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Telephone | 567-231-7737
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Fax |
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Provider Business Mailing Address
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Address Line | 92 W ELM ST
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City | BUTLER
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State | OH
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Zip | 44822-8938
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Country | US
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Telephone | 567-231-7737
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | CDCA.174236
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License Number State | OH
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