Provider Demographics
NPI:1003898222
Name:TELLES, PATRICIA MARIE (PHS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIE
Last Name:TELLES
Suffix:
Gender:F
Credentials:PHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 GENE AVE NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-5405
Mailing Address - Country:US
Mailing Address - Phone:505-345-6772
Mailing Address - Fax:505-246-8973
Practice Address - Street 1:652 GENE AVE NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-5405
Practice Address - Country:US
Practice Address - Phone:505-345-6772
Practice Address - Fax:505-246-8973
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM.0588101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional