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NPI Code Detail

MEDICARE: JONATHAN TEAGUE

MEDICARE: JONATHAN TEAGUE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorP2201001AR

General Provider Information

NPI Number : 1407351562
Entity Type Code : Individual
Provider Name (Legal Business Name) : JONATHAN TEAGUE
Provider Business Mailing Address
First Line : PO BOX 1589
Second Line :
City : BENTON
State : AR
Zip : 72018-1589
Country : US
Telephone Number : 501-315-3344
Fax Number : 501-661-1812
Provider Business Practice Location Address
First Line : 522 MILL RD
Second Line :
City : CLARKSVILLE
State : AR
Zip : 72830-8511
Country : US
Telephone Number : 501-315-3344
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2018
Last Update Date : 06/13/2026

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Directions to “ JONATHAN TEAGUE ” Practice Location

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