Provider Demographics
NPI:1437930658
Name:TELLO, FAITH CAROL
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:CAROL
Last Name:TELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 E 29TH ST N APT 1412
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2247
Mailing Address - Country:US
Mailing Address - Phone:316-207-6921
Mailing Address - Fax:
Practice Address - Street 1:8080 E CENTRAL AVE STE 230
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2369
Practice Address - Country:US
Practice Address - Phone:316-721-8118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04514-T101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health