Provider Demographics
NPI:1700097672
Name:TEAGUE, MICHAEL H (MSW, LADAC, LMSW,)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:H
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:MSW, LADAC, LMSW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10040
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-1140
Mailing Address - Country:US
Mailing Address - Phone:870-972-6199
Mailing Address - Fax:870-972-6199
Practice Address - Street 1:2913 KING ST
Practice Address - Street 2:SUITE 4
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5322
Practice Address - Country:US
Practice Address - Phone:870-972-6199
Practice Address - Fax:870-972-6199
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0006-L101YA0400X
AR758-M1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical