Provider Demographics
NPI:1376766998
Name:TEAGUE, JOWANNA S (BA,BHRS,CBHCM-D)
Entity Type:Individual
Prefix:
First Name:JOWANNA
Middle Name:S
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:BA,BHRS,CBHCM-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 79 BOX 142
Mailing Address - Street 2:
Mailing Address - City:HUGO
Mailing Address - State:OK
Mailing Address - Zip Code:74743-9323
Mailing Address - Country:US
Mailing Address - Phone:580-326-7845
Mailing Address - Fax:580-298-6699
Practice Address - Street 1:100 N 5TH ST
Practice Address - Street 2:
Practice Address - City:HUGO
Practice Address - State:OK
Practice Address - Zip Code:74743-4005
Practice Address - Country:US
Practice Address - Phone:580-326-9475
Practice Address - Fax:580-326-9028
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TR0400X
LPC07098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation