Provider Demographics
NPI:1063051837
Name:TEAGUE, BRITTANY
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:TEAGUE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 TWIN OAKS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2723
Mailing Address - Country:US
Mailing Address - Phone:940-696-0181
Mailing Address - Fax:940-696-5692
Practice Address - Street 1:1420 TWIN OAKS ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2723
Practice Address - Country:US
Practice Address - Phone:940-696-0181
Practice Address - Fax:940-696-5692
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-27
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional