Provider Demographics
NPI:1760910004
Name:TEELE, AMBER MARIE (LPC, SAC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MARIE
Last Name:TEELE
Suffix:
Gender:F
Credentials:LPC, SAC, NCC
Other - Prefix:MISS
Other - First Name:AMBER
Other - Middle Name:MARIE
Other - Last Name:GROVOGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAC-IT
Mailing Address - Street 1:3049 RAMADA WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54304-5576
Mailing Address - Country:US
Mailing Address - Phone:920-482-2932
Mailing Address - Fax:800-892-6147
Practice Address - Street 1:3049 RAMADA WAY STE 200
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-5576
Practice Address - Country:US
Practice Address - Phone:920-482-2932
Practice Address - Fax:800-892-6147
Is Sole Proprietor?:No
Enumeration Date:2017-05-31
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16424-131101YA0400X
WI8037-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760910004Medicaid