Healthcare Provider Details

I. General information

NPI: 1356634026
Provider Name (Legal Business Name): TEAGUE, TEAGUE & ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2011
Last Update Date: 06/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N HIGHLAND AVE
MURFREESBORO TN
37130-2461
US

IV. Provider business mailing address

3340 BLAZE DR
MURFREESBORO TN
37128-3878
US

V. Phone/Fax

Practice location:
  • Phone: 615-809-5995
  • Fax: 615-898-5027
Mailing address:
  • Phone: 615-809-5995
  • Fax: 615-898-5027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2170
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2170
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5132
License Number StateTN

VIII. Authorized Official

Name: DR. COREY M. TEAGUE
Title or Position: CEO/PSYCHOLOGIST
Credential: PHD, LPC, MHSP, NCC
Phone: 615-809-5995