Provider Demographics
NPI:1578107157
Name:TEEHAN, CHAUNTE ELIZABETH (MA, LPCC)
Entity Type:Individual
Prefix:MRS
First Name:CHAUNTE
Middle Name:ELIZABETH
Last Name:TEEHAN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20709 IDAHO AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-5875
Mailing Address - Country:US
Mailing Address - Phone:651-315-4267
Mailing Address - Fax:
Practice Address - Street 1:7064 W POINT DOUGLAS RD S STE 201
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-2691
Practice Address - Country:US
Practice Address - Phone:651-315-4267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional