Healthcare Provider Details

I. General information

NPI: 1730817461
Provider Name (Legal Business Name): SOPHIE TEAGUE MS, LADC, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIE LEONARD

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 KENNARD ST STE 250
MAPLEWOOD MN
55109-5465
US

IV. Provider business mailing address

1370 MENDOTA HEIGHTS RD
MENDOTA HEIGHTS MN
55120-1281
US

V. Phone/Fax

Practice location:
  • Phone: 651-313-8080
  • Fax:
Mailing address:
  • Phone: 651-313-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number306416
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number5332
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: