Provider Demographics
NPI:1245549062
Name:TEASLEY, BOBBI JO (LPC, ALPS)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:JO
Last Name:TEASLEY
Suffix:
Gender:
Credentials:LPC, ALPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:RAVENSWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26164-1634
Mailing Address - Country:US
Mailing Address - Phone:304-377-1194
Mailing Address - Fax:
Practice Address - Street 1:705 WASHINGTON ST # A
Practice Address - Street 2:
Practice Address - City:RAVENSWOOD
Practice Address - State:WV
Practice Address - Zip Code:26164-1729
Practice Address - Country:US
Practice Address - Phone:304-868-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2025-04-17
Deactivation Date:2020-01-15
Deactivation Code:
Reactivation Date:2020-01-24
Provider Licenses
StateLicense IDTaxonomies
WV2386101YP2500X
MT30843101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional