Provider Demographics
NPI:1437261401
Name:TEED, DAVID A (LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:TEED
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 W AMERICANA TER STE 310B
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2548
Mailing Address - Country:US
Mailing Address - Phone:208-424-3105
Mailing Address - Fax:208-514-1534
Practice Address - Street 1:3350 W AMERICANA TER STE 310B
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2548
Practice Address - Country:US
Practice Address - Phone:208-424-3105
Practice Address - Fax:208-514-1534
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW10311041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1691072Medicare ID - Type Unspecified