Healthcare Provider Details

I. General information

NPI: 1144735168
Provider Name (Legal Business Name): TERESA L SCAGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2066 W APACHE TRL STE 101
APACHE JUNCTION AZ
85120-3733
US

IV. Provider business mailing address

375 LAFAYETTE AVE
FAYETTEVILLE GA
30214-1813
US

V. Phone/Fax

Practice location:
  • Phone: 480-999-3323
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-15819
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: