Provider Demographics
NPI:1982075214
Name:TEAT, WANDA SUE (LMHC)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:SUE
Last Name:TEAT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32329-0532
Mailing Address - Country:US
Mailing Address - Phone:850-653-8383
Mailing Address - Fax:
Practice Address - Street 1:1581 HIGHWAY 98 E.
Practice Address - Street 2:STE C
Practice Address - City:CARRABELLE
Practice Address - State:FL
Practice Address - Zip Code:32322-2208
Practice Address - Country:US
Practice Address - Phone:850-653-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12834101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health