Provider Demographics
NPI:1932403797
Name:MCKEAN, TERI (LCSW)
Entity Type:Individual
Prefix:
First Name:TERI
Middle Name:
Last Name:MCKEAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E LINCOLN ST
Mailing Address - Street 2:STE 303
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-6406
Mailing Address - Country:US
Mailing Address - Phone:309-451-9495
Mailing Address - Fax:309-451-9404
Practice Address - Street 1:201 W SPRINGFIELD AVE
Practice Address - Street 2:STE 1006
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-6385
Practice Address - Country:US
Practice Address - Phone:217-403-0790
Practice Address - Fax:217-403-0885
Is Sole Proprietor?:No
Enumeration Date:2011-01-07
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178007084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health