Provider Demographics
NPI:1033257258
Name:TELZROW, JOHN MICHAEL (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:TELZROW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24700 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 314
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5636
Mailing Address - Country:US
Mailing Address - Phone:440-871-2121
Mailing Address - Fax:440-871-2121
Practice Address - Street 1:24700 CENTER RIDGE RD
Practice Address - Street 2:SUITE 314
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5636
Practice Address - Country:US
Practice Address - Phone:440-871-2121
Practice Address - Fax:440-871-2121
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2037103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0388156Medicaid