Individual
CARSON TEAGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
261 MACK AVE STE 555, DETROIT, MI 48201-2417
(313) 745-9763
(313) 745-9854
Mailing address
261 MACK AVE STE 555, DETROIT, MI 48201-2417
(313) 745-9763
(313) 745-9854
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
6301019342
MI
103T00000X
Psychologist
6301019342
MI
Other
Enumeration date
11/08/2023
Last updated
02/03/2025
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