Provider Demographics
NPI:1083882062
Name:BEAR, TEDDY M (LSW)
Entity Type:Individual
Prefix:MR
First Name:TEDDY
Middle Name:M
Last Name:BEAR
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:MR
Other - First Name:TEDDY
Other - Middle Name:M
Other - Last Name:BEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:901 WASHI NGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-355-8606
Mailing Address - Fax:740-353-1662
Practice Address - Street 1:901 WASHI NGTON ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662
Practice Address - Country:US
Practice Address - Phone:740-355-8606
Practice Address - Fax:740-353-1662
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0700438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health