Provider Demographics
NPI:1598007429
Name:TELLIS, NUBIA (MA, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:NUBIA
Middle Name:
Last Name:TELLIS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:NUBIA
Other - Middle Name:MARCELA
Other - Last Name:OFFENBURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:30981 PASEO VALENCIA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2948
Mailing Address - Country:US
Mailing Address - Phone:951-202-4938
Mailing Address - Fax:
Practice Address - Street 1:31831 CAMINO CAPISTRANO
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-3211
Practice Address - Country:US
Practice Address - Phone:949-676-6705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA87024106H00000X
CA132447106H00000X
1-14-10004103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist