Provider Demographics
NPI:1699388769
Name:TEETERS, JUSTIN DEAN (CDCA)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DEAN
Last Name:TEETERS
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:OH
Mailing Address - Zip Code:44822-8938
Mailing Address - Country:US
Mailing Address - Phone:567-231-7737
Mailing Address - Fax:
Practice Address - Street 1:1012 ODNR MOHICAN 51
Practice Address - Street 2:
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864-9407
Practice Address - Country:US
Practice Address - Phone:567-231-7737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.174236101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)