Provider Demographics
NPI:1164432118
Name:TELLURIAN, INC.
Entity Type:Organization
Organization Name:TELLURIAN, INC.
Other - Org Name:MENTAL HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:QUALITY ASSURANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MUELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-204-8547
Mailing Address - Street 1:1053 WILLIAMSON ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-3525
Mailing Address - Country:US
Mailing Address - Phone:608-258-3446
Mailing Address - Fax:608-258-3445
Practice Address - Street 1:1053 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-3525
Practice Address - Country:US
Practice Address - Phone:608-258-3446
Practice Address - Fax:608-258-3445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TELLURIAN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-09
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty