Provider Demographics
NPI:1083995237
Name:WILBER, TEONNA MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:TEONNA
Middle Name:MARIE
Last Name:WILBER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4239 AUGUSTA DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8962
Mailing Address - Country:US
Mailing Address - Phone:219-713-4138
Mailing Address - Fax:
Practice Address - Street 1:1465 E 84TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6451
Practice Address - Country:US
Practice Address - Phone:219-649-1758
Practice Address - Fax:219-525-4337
Is Sole Proprietor?:No
Enumeration Date:2011-09-01
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010554101YP2500X
IN39002463A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional