NPI Code Detail JSON Logo

1760910004 NPI number — AMBER MARIE TEELE LPC, SAC, NCC

NPI Number: 1760910004
Health Care Provider/Practitioner: AMBER MARIE TEELE LPC, SAC, NCC

Information about “1760910004” NPI (AMBER MARIE TEELE LPC, SAC, NCC) exists in 1760910004 in HTML format HTML  |  1760910004 in plain Text format TXT  |  1760910004 in PDF (Portable Document Format) PDF  |  1760910004 in an XML format XML  formats.

NPI Number : 1760910004 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1760910004",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TEELE",
    "FirstName": "AMBER",
    "MiddleName": "MARIE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "LPC, SAC, NCC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GROVOGEL",
    "OtherFirstName": "AMBER",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "SAC-IT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3049 RAMADA WAY STE 200",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREEN BAY",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54304-5576",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "920-482-2932",
    "MailingAddressFaxNumber": "800-892-6147",
    "FirstLinePracticeLocationAddress": "3049 RAMADA WAY STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREEN BAY",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54304-5576",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "920-482-2932",
    "PracticeLocationAddressFaxNumber": "800-892-6147",
    "EnumerationDate": "05/31/2017",
    "LastUpdateDate": "02/05/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "101YA0400X",
          "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
          "LicenseNumber": "16424-131",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101YM0800X",
          "TaxonomyName": "Mental Health Counselor",
          "LicenseNumber": "8037-125",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.