Healthcare Provider Details

I. General information

NPI: 1326918087
Provider Name (Legal Business Name): DEVIEON TEAGUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 S EMERSON AVE STE 100
INDIANAPOLIS IN
46237-1972
US

IV. Provider business mailing address

210 WELCOME WAY BLVD W
INDIANAPOLIS IN
46214-3084
US

V. Phone/Fax

Practice location:
  • Phone: 317-567-9307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: