Provider Demographics
NPI:1336444538
Name:TEGGART, LINANN MAY (PCC)
Entity Type:Individual
Prefix:
First Name:LINANN
Middle Name:MAY
Last Name:TEGGART
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E COURT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2467
Mailing Address - Country:US
Mailing Address - Phone:419-575-7910
Mailing Address - Fax:419-386-0981
Practice Address - Street 1:141 E COURT ST
Practice Address - Street 2:SUITE B
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2467
Practice Address - Country:US
Practice Address - Phone:419-575-7910
Practice Address - Fax:419-386-0981
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0900343101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0900343Medicaid