Provider Demographics
NPI:1619249182
Name:TELCH, MICHAEL J (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:TELCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2329 WESTLAKE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-2953
Mailing Address - Country:US
Mailing Address - Phone:512-404-9118
Mailing Address - Fax:512-590-8657
Practice Address - Street 1:2329 WESTLAKE DR
Practice Address - Street 2:APT 4
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-2964
Practice Address - Country:US
Practice Address - Phone:512-404-9118
Practice Address - Fax:512-590-8657
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-3316103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral