Provider Demographics
NPI:1467514224
Name:TELLIER, SCOTT ROBERT (MS,LCMHC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:ROBERT
Last Name:TELLIER
Suffix:
Gender:M
Credentials:MS,LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-5115
Mailing Address - Country:US
Mailing Address - Phone:401-294-6050
Mailing Address - Fax:401-294-6090
Practice Address - Street 1:191 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-5115
Practice Address - Country:US
Practice Address - Phone:401-294-6050
Practice Address - Fax:401-294-6090
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00098101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI22608-8OtherBLUE CROSS
RI62-62525OtherUNITED HEALTHCARE OF N.E.
RI406647OtherBLUE CHIP
RI1029690OtherBEACON HEALTH STRATEGIES