Provider Demographics
NPI:1992263248
Name:TEATER, DANIEL STEPHEN (LPC, MDIV, MAC)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:STEPHEN
Last Name:TEATER
Suffix:
Gender:M
Credentials:LPC, MDIV, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5947 WATERMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-1517
Mailing Address - Country:US
Mailing Address - Phone:314-518-1616
Mailing Address - Fax:
Practice Address - Street 1:11780 BORMAN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4135
Practice Address - Country:US
Practice Address - Phone:314-479-9028
Practice Address - Fax:866-387-2869
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012029760101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor