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General NPI Number Information
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NPI Number | 1083963151
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Entity Type | Individual
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Provider Name | PHERNYA TEAGUE
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Gender | Female
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 2814 S US HIGHWAY 1 SUITE D-4
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City | FORT PIERCE
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State | FL
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Zip | 34982-8120
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Country | US
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Telephone | 469-398-9708
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Fax |
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Provider Business Mailing Address
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Address Line | 3590 NW TREASURE COAST DR APT 101
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City | JENSEN BEACH
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State | FL
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Zip | 34957-4480
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Country | US
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Telephone | 469-398-9708
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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