Provider Demographics
NPI:1356634026
Name:TEAGUE, TEAGUE & ASSOCIATES
Entity Type:Organization
Organization Name:TEAGUE, TEAGUE & ASSOCIATES
Other - Org Name:TEAGUE AND TEAGUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, MHSP, NCC
Authorized Official - Phone:615-809-5995
Mailing Address - Street 1:3340 BLAZE DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3878
Mailing Address - Country:US
Mailing Address - Phone:615-809-5995
Mailing Address - Fax:615-898-5027
Practice Address - Street 1:625 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2461
Practice Address - Country:US
Practice Address - Phone:615-809-5995
Practice Address - Fax:615-898-5027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2170101YM0800X, 101YP2500X
TN51321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty