Provider Demographics
NPI:1174262927
Name:TELLIER, ADAM (CCM, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:TELLIER
Suffix:
Gender:M
Credentials:CCM, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9564 ROCKYBROOK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4055
Mailing Address - Country:US
Mailing Address - Phone:916-549-4676
Mailing Address - Fax:
Practice Address - Street 1:9564 ROCKYBROOK WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4055
Practice Address - Country:US
Practice Address - Phone:916-234-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical