Healthcare Provider Details

I. General information

NPI: 1336562842
Provider Name (Legal Business Name): BARBARA TEAGUE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2014
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 GREATSTONE PT
LEXINGTON KY
40504-3274
US

IV. Provider business mailing address

2412 GREATSTONE PT
LEXINGTON KY
40504-3274
US

V. Phone/Fax

Practice location:
  • Phone: 859-224-4081
  • Fax: 859-224-4082
Mailing address:
  • Phone: 859-224-4081
  • Fax: 859-224-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberKY-1110
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: