Provider Demographics
NPI:1326760653
Name:WHYTE, TEELA D (LSW)
Entity Type:Individual
Prefix:
First Name:TEELA
Middle Name:D
Last Name:WHYTE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 HONEYSUCKLE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5624
Mailing Address - Country:US
Mailing Address - Phone:217-638-3250
Mailing Address - Fax:
Practice Address - Street 1:5850 6TH STREET FRONTAGE RD E STE A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-5194
Practice Address - Country:US
Practice Address - Phone:217-529-5046
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150103182104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker