Provider Demographics
NPI:1417425984
Name:TEETERS, NATALIE JEAN (MS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:JEAN
Last Name:TEETERS
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 1:2204 18TH AVE STE 126
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-9722
Mailing Address - Country:US
Mailing Address - Phone:720-795-4914
Mailing Address - Fax:
Practice Address - Street 1:2204 18TH AVE STE 126
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-9722
Practice Address - Country:US
Practice Address - Phone:720-795-4914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0108501101YM0800X
MFT.0001943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health