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General NPI Number Information
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NPI Number | 1730817461
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Entity Type | Individual
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Provider Name | SOPHIE TEAGUE MS, LADC, LPCC
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Gender | Female
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Dates
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Enumeration Date | 08/10/2022
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 3100 KENNARD ST STE 250
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City | MAPLEWOOD
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State | MN
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Zip | 55109-5465
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Country | US
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Telephone | 651-313-8080
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Fax |
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Provider Business Mailing Address
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Address Line | 1370 MENDOTA HEIGHTS RD
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City | MENDOTA HEIGHTS
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State | MN
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Zip | 55120-1281
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Country | US
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Telephone | 651-313-8080
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 306416
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5332
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License Number State | MN
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