Provider Demographics
NPI:1225704505
Name:TEAGUE, CHRYSTAL ARMELLE (LICENSED ESTHETICIAN)
Entity Type:Individual
Prefix:MS
First Name:CHRYSTAL
Middle Name:ARMELLE
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:LICENSED ESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-6322
Mailing Address - Country:US
Mailing Address - Phone:469-298-2435
Mailing Address - Fax:
Practice Address - Street 1:613 MAIN ST
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-6322
Practice Address - Country:US
Practice Address - Phone:469-298-2435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1568848174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist