Provider Demographics
NPI:1487370052
Name:DAVID A. TEED, CSWP, PA
Entity type:Organization
Organization Name:DAVID A. TEED, CSWP, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:TEED
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-484-1446
Mailing Address - Street 1:3350 W AMERICANA TER STE 310B
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-2548
Mailing Address - Country:US
Mailing Address - Phone:208-484-1446
Mailing Address - Fax:208-514-1534
Practice Address - Street 1:3350 W AMERICANA TER STE 310B
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-2548
Practice Address - Country:US
Practice Address - Phone:208-484-1446
Practice Address - Fax:208-514-1534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLCSW-1031OtherSTATE LICENSURE