Provider Demographics
NPI:1578007001
Name:TEAGUE, DESTINY RAEANN (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:DESTINY
Middle Name:RAEANN
Last Name:TEAGUE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:DESI
Other - Middle Name:R
Other - Last Name:TEAGUE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:9514 ARCADE DR
Mailing Address - Street 2:
Mailing Address - City:KLEIN
Mailing Address - State:TX
Mailing Address - Zip Code:77379-6644
Mailing Address - Country:US
Mailing Address - Phone:832-529-6172
Mailing Address - Fax:
Practice Address - Street 1:6601 CYPRESSWOOD DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7891
Practice Address - Country:US
Practice Address - Phone:832-529-6172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional