Healthcare Provider Details

I. General information

NPI: 1376766998
Provider Name (Legal Business Name): JOWANNA S TEAGUE BA,BHRS,CBHCM-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 5TH ST
HUGO OK
74743-4005
US

IV. Provider business mailing address

HC 79 BOX 142
HUGO OK
74743-9323
US

V. Phone/Fax

Practice location:
  • Phone: 580-326-9475
  • Fax: 580-326-9028
Mailing address:
  • Phone: 580-326-7845
  • Fax: 580-298-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC07098
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: