Provider Demographics
NPI:1043649213
Name:SEGUIN, TEENA MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:TEENA
Middle Name:MARIE
Last Name:SEGUIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W BROADWAY STE 107
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4489
Mailing Address - Country:US
Mailing Address - Phone:712-328-3700
Mailing Address - Fax:712-328-3721
Practice Address - Street 1:300 W BROADWAY STE 107
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4489
Practice Address - Country:US
Practice Address - Phone:712-328-3700
Practice Address - Fax:712-328-3721
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0078911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical