Provider Demographics
NPI:1295567790
Name:TEAGUE, BRYAN (LPC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 HILTON DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-5577
Mailing Address - Country:US
Mailing Address - Phone:817-789-3168
Mailing Address - Fax:
Practice Address - Street 1:8813 N TARRANT PKWY STE 242
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76182-8419
Practice Address - Country:US
Practice Address - Phone:817-789-3168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85662101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional