Provider Demographics
NPI:1346627411
Name:WANDA TEAT COUNSELING LLC
Entity Type:Organization
Organization Name:WANDA TEAT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:TEAT
Authorized Official - Suffix:
Authorized Official - Credentials:MH12834
Authorized Official - Phone:850-653-5014
Mailing Address - Street 1:1581 HIGHWAY 98 W
Mailing Address - Street 2:
Mailing Address - City:CARRABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:32322-5009
Mailing Address - Country:US
Mailing Address - Phone:850-653-8383
Mailing Address - Fax:
Practice Address - Street 1:1 TEAT ROAD
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32329
Practice Address - Country:US
Practice Address - Phone:850-653-8383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty