Individual
MRS. MARY TEACHOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPA, CPC, NCC
Contact information
Practice address
1107 US HIGHWAY 395 N, GARDNERVILLE, NV 89410-5304
(248) 390-4264
Mailing address
1107 US HIGHWAY 395 N, GARDNERVILLE, NV 89410-5304
(248) 390-4264
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
107328
AK
101YP2500X
Professional Counselor
2106
NE
101YP2500X
Professional Counselor
6401010522
MI
101YP2500X
Professional Counselor
889
MN
101YP2500X
Professional Counselor
Primary
CP1149-R
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1020986
—
AK
01
—
12183880
CAQH
MI
Enumeration date
01/18/2011
Last updated
05/13/2019
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