Provider Demographics
NPI:1619174489
Name:TETEAK-BERG, HEATHER L (LCPC, NCC, CCTP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:TETEAK-BERG
Suffix:
Gender:F
Credentials:LCPC, NCC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2244 95TH ST UNIT 218
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8033
Mailing Address - Country:US
Mailing Address - Phone:630-677-1849
Mailing Address - Fax:630-717-1165
Practice Address - Street 1:2244 95TH ST UNIT 218
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8033
Practice Address - Country:US
Practice Address - Phone:630-677-1849
Practice Address - Fax:630-717-1165
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-000428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02232187OtherBLUE CROSS BLUE SHIELD
IL28872OtherNCC
211652OtherEVERGREEN CERTIFICATIONS--CERTIFIED CLINICAL TRAUMA PROFESSIONAL
IL180-000428OtherLCPC
S-1163OtherASSOCIATION FOR PLAY THERAPY