Provider Demographics
NPI:1528766334
Name:TEETER, DANA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:TEETER
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 1:602 S COLFAX ST
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-4623
Mailing Address - Country:US
Mailing Address - Phone:815-325-8155
Mailing Address - Fax:
Practice Address - Street 1:602 S COLFAX ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4623
Practice Address - Country:US
Practice Address - Phone:815-325-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007041A1041C0700X
171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171400000XOther Service ProvidersHealth & Wellness Coach