Provider Demographics
NPI:1912191057
Name:TEETOR, STEVEN ERIC (MA, LPA)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ERIC
Last Name:TEETOR
Suffix:
Gender:M
Credentials:MA, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27855-2112
Mailing Address - Country:US
Mailing Address - Phone:252-396-8405
Mailing Address - Fax:
Practice Address - Street 1:500 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:NC
Practice Address - Zip Code:27855-2112
Practice Address - Country:US
Practice Address - Phone:252-396-8405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2147103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical