Provider Demographics
NPI:1992771539
Name:OEHLER, TEANNE (LISW)
Entity type:Individual
Prefix:
First Name:TEANNE
Middle Name:
Last Name:OEHLER
Suffix:
Gender:F
Credentials:LISW
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 3303
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29578-3303
Mailing Address - Country:US
Mailing Address - Phone:843-946-3507
Mailing Address - Fax:843-946-3507
Practice Address - Street 1:1601 N OAK ST
Practice Address - Street 2:SUITE 107
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-3579
Practice Address - Country:US
Practice Address - Phone:843-946-3577
Practice Address - Fax:843-946-3507
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC000138101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQM0167Medicaid