MEDICARE: MRS. RUTH ANN TEAGUE LPC AND LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	04377	TX
2	106H00000X	Marriage & Family Therapist	03339	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164519724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTH ANN TEAGUE LPC AND LMFT

Provider Business Mailing Address
First Line	:	5000 WHITE OAK LANE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76114
Country	:	US
Telephone Number	:	817-625-0975
Fax Number	:	817-282-6128

Provider Business Practice Location Address
First Line	:	5000 WHITE OAK LANE
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76114
Country	:	US
Telephone Number	:	817-282-3323
Fax Number	:	817-282-6128

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	09/11/2025

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