Provider Demographics
NPI:1639460546
Name:TEETS, HUNTER (MA)
Entity Type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:TEETS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 FOREST ST STE B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5267
Mailing Address - Country:US
Mailing Address - Phone:303-718-6482
Mailing Address - Fax:
Practice Address - Street 1:618 FOREST ST STE B
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5267
Practice Address - Country:US
Practice Address - Phone:303-718-6482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12489101Y00000X
VA0701005525101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor