Provider Demographics
NPI:1437572450
Name:JOCELYN TELLO PSYD INC
Entity Type:Organization
Organization Name:JOCELYN TELLO PSYD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOCELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TELLO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:360-931-0605
Mailing Address - Street 1:400 E EVERGREEN BLVD
Mailing Address - Street 2:SUITE 313
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98660-3331
Mailing Address - Country:US
Mailing Address - Phone:360-931-0605
Mailing Address - Fax:360-859-4533
Practice Address - Street 1:400 E EVERGREEN BLVD
Practice Address - Street 2:SUITE 313
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98660-3331
Practice Address - Country:US
Practice Address - Phone:360-931-0605
Practice Address - Fax:360-859-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003900261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8888762Medicare UPIN