Healthcare Provider Details

I. General information

NPI: 1215123674
Provider Name (Legal Business Name): JENNA LOUISE TEAGUE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BRAND BLVD STE 700
GLENDALE CA
91203-2336
US

IV. Provider business mailing address

34052 DOHENY PARK RD SPC 69
CAPISTRANO BEACH CA
92624-3142
US

V. Phone/Fax

Practice location:
  • Phone: 415-717-3833
  • Fax:
Mailing address:
  • Phone: 415-717-3833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: