Provider Demographics
NPI:1669640777
Name:TEAL, JOHN A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:TEAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5821
Mailing Address - Country:US
Mailing Address - Phone:601-946-1844
Mailing Address - Fax:
Practice Address - Street 1:633 ASBURY DR
Practice Address - Street 2:SUITE A
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-6511
Practice Address - Country:US
Practice Address - Phone:601-946-1844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS47818103TC0700X
LAMP.000036103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical