Provider Demographics
NPI:1083963151
Name:TEAGUE, PHERNYA
Entity Type:Individual
Prefix:
First Name:PHERNYA
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3590 NW TREASURE COAST DR APT 101
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-4480
Mailing Address - Country:US
Mailing Address - Phone:469-398-9708
Mailing Address - Fax:
Practice Address - Street 1:2814 S US HIGHWAY 1
Practice Address - Street 2:SUITE D-4
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8120
Practice Address - Country:US
Practice Address - Phone:469-398-9708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional