Provider Demographics
NPI:1063637023
Name:TELLER, EARL HOWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:EARL
Middle Name:HOWARD
Last Name:TELLER
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 1:5237 CLOVER MIST DR.
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572
Mailing Address - Country:US
Mailing Address - Phone:813-728-1962
Mailing Address - Fax:813-641-9792
Practice Address - Street 1:5237 CLOVER MIST DR.
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572
Practice Address - Country:US
Practice Address - Phone:813-728-1962
Practice Address - Fax:813-641-9792
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7429103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical