Provider Demographics
NPI:1497973929
Name:TELLES, JOHN R (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:TELLES
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2464 N MI CASA CIR
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85222-1121
Mailing Address - Country:US
Mailing Address - Phone:520-723-7405
Mailing Address - Fax:520-723-7410
Practice Address - Street 1:556 S ARIZONA BLVD
Practice Address - Street 2:
Practice Address - City:COOLIDGE
Practice Address - State:AZ
Practice Address - Zip Code:85228-5103
Practice Address - Country:US
Practice Address - Phone:520-723-7405
Practice Address - Fax:520-723-7410
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-122321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical