Provider Demographics
NPI:1497315717
Name:TELLO, AURA ISABEL
Entity Type:Individual
Prefix:
First Name:AURA
Middle Name:ISABEL
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 1:1144 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8404
Mailing Address - Country:US
Mailing Address - Phone:386-473-3022
Mailing Address - Fax:
Practice Address - Street 1:1144 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8404
Practice Address - Country:US
Practice Address - Phone:386-473-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor