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General NPI Number Information
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NPI Number | 1992263248
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Entity Type | Individual
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Provider Name | DANIEL STEPHEN TEATER LPC, M.DIV, MAC
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Gender | Male
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Dates
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Enumeration Date | 03/06/2019
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Last Update Date | 03/06/2019
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Provider Practice Location Address
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Address Line | 11780 BORMAN DR
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4135
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Country | US
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Telephone | 314-479-9028
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Fax | 866-387-2869
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Provider Business Mailing Address
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Address Line | 5947 WATERMAN BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63112-1517
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Country | US
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Telephone | 314-518-1616
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2012029760
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License Number State | MO
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