Provider Demographics
NPI:1366279200
Name:SHUCK, TERESA L (LPC; LPC-MH)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:SHUCK
Suffix:
Gender:F
Credentials:LPC; LPC-MH
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 453
Mailing Address - Street 2:
Mailing Address - City:KADOKA
Mailing Address - State:SD
Mailing Address - Zip Code:57543-0453
Mailing Address - Country:US
Mailing Address - Phone:605-269-1712
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 453
Practice Address - Street 2:
Practice Address - City:KADOKA
Practice Address - State:SD
Practice Address - Zip Code:57543
Practice Address - Country:US
Practice Address - Phone:605-269-1712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LPCMH30928101YP2500X
SDLPC20805101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional