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NPI Code Detail

MEDICARE: MS. JENNA LOUISE TEAGUE M.A.

MEDICARE: MS. JENNA LOUISE TEAGUE M.A.
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
1174H00000XHealth Educator
2171400000XHealth & Wellness Coach
3101Y00000XCounselor
4101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1215123674
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNA LOUISE TEAGUE M.A.
Provider Business Mailing Address
First Line : 34052 DOHENY PARK RD SPC 69
Second Line :
City : CAPISTRANO BEACH
State : CA
Zip : 92624-3142
Country : US
Telephone Number : 415-717-3833
Fax Number :
Provider Business Practice Location Address
First Line : 330 N BRAND BLVD STE 700
Second Line :
City : GLENDALE
State : CA
Zip : 91203-2336
Country : US
Telephone Number : 415-717-3833
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2007
Last Update Date : 02/25/2025

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