Provider Demographics
NPI:1922542695
Name:TEIPNER, TERRY (MS, LPC, LMFT-IT)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:
Last Name:TEIPNER
Suffix:
Gender:M
Credentials:MS, LPC, LMFT-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 FREDERICK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1056
Mailing Address - Country:US
Mailing Address - Phone:608-513-9925
Mailing Address - Fax:
Practice Address - Street 1:1173 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190
Practice Address - Country:US
Practice Address - Phone:608-513-9925
Practice Address - Fax:262-458-2680
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6930-125101YP2500X
WI6930125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional