Individual
JONATHAN TEAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6701 HIGHWAY 67, BENTON, AR 72015-8909
(501) 315-3344
Mailing address
PO BOX 1589, BENTON, AR 72018-1589
(501) 315-3344
(501) 661-1812
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
A1807075
AR
101YP2500X
Professional Counselor
Primary
P2201001
AR
Other
Enumeration date
03/29/2018
Last updated
01/31/2022
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