Provider Demographics
NPI:1336240423
Name:TEAGUE, COREY MARTEZ (PHD, LPC, MHSP, NCC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MARTEZ
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:PHD, LPC, MHSP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 BLAZE DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-3878
Mailing Address - Country:US
Mailing Address - Phone:615-890-5995
Mailing Address - Fax:
Practice Address - Street 1:855 W COLLEGE ST
Practice Address - Street 2:SUITE H
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2762
Practice Address - Country:US
Practice Address - Phone:615-809-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2170101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional