Provider Demographics
NPI:1851566913
Name:TEICHMAN, BETTY J (LPC)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:J
Last Name:TEICHMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-8985
Mailing Address - Country:US
Mailing Address - Phone:570-204-6456
Mailing Address - Fax:570-752-3387
Practice Address - Street 1:1051 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-8985
Practice Address - Country:US
Practice Address - Phone:570-204-6456
Practice Address - Fax:570-752-3387
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional