MEDICARE: TEAGUE RICHARD COWLEY

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1831709559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEAGUE RICHARD COWLEY

Provider Business Mailing Address
First Line	:	6300 SAGEWOOD DR STE H-411
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-7502
Country	:	US
Telephone Number	:	801-382-8604
Fax Number	:

Provider Business Practice Location Address
First Line	:	6300 SAGEWOOD DR STE H-411
Second Line	:
City	:	PARK CITY
State	:	UT
Zip	:	84098-7502
Country	:	US
Telephone Number	:	801-382-8604
Fax Number	:

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

Provider Enumeration Date	:	08/06/2020
Last Update Date	:	12/10/2025

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Directions to “ TEAGUE RICHARD COWLEY ” Practice Location

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