Provider Demographics
NPI:1437598919
Name:ABRAM, TELLIS TERRELL (LMSW)
Entity Type:Individual
Prefix:
First Name:TELLIS
Middle Name:TERRELL
Last Name:ABRAM
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1914 S GAUDIN AVE
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:LA
Mailing Address - Zip Code:70737-4147
Mailing Address - Country:US
Mailing Address - Phone:225-450-1170
Mailing Address - Fax:
Practice Address - Street 1:1914 S GAUDIN AVE
Practice Address - Street 2:
Practice Address - City:GONZALES
Practice Address - State:LA
Practice Address - Zip Code:70737-4147
Practice Address - Country:US
Practice Address - Phone:225-450-1170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA86261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical