Provider Demographics
NPI:1093896458
Name:TEINI, STEPHANNIE ANN (MS)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANNIE
Middle Name:ANN
Last Name:TEINI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-2825
Mailing Address - Country:US
Mailing Address - Phone:307-399-0597
Mailing Address - Fax:
Practice Address - Street 1:2604 OVERLAND RD
Practice Address - Street 2:
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-2825
Practice Address - Country:US
Practice Address - Phone:307-399-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-332101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor