Provider Demographics
NPI:1215123674
Name:TEAGUE, JENNA LOUISE (MA)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:LOUISE
Last Name:TEAGUE
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34052 DOHENY PARK RD SPC 69
Mailing Address - Street 2:
Mailing Address - City:CAPISTRANO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92624-3142
Mailing Address - Country:US
Mailing Address - Phone:415-717-3833
Mailing Address - Fax:
Practice Address - Street 1:330 N BRAND BLVD STE 700
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2336
Practice Address - Country:US
Practice Address - Phone:415-717-3833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health