Provider Demographics
NPI:1417724766
Name:TEETER, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:TEETER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BOB
Other - Middle Name:
Other - Last Name:TEETER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1139 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4441
Mailing Address - Country:US
Mailing Address - Phone:918-687-7064
Mailing Address - Fax:918-683-1983
Practice Address - Street 1:1139 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-4441
Practice Address - Country:US
Practice Address - Phone:918-687-7064
Practice Address - Fax:918-683-1983
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-06
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor