Provider Demographics
NPI:1619342979
Name:TELLER, LOUIS TODD (PHD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:TODD
Last Name:TELLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BRUCE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:18966-2196
Mailing Address - Country:US
Mailing Address - Phone:215-280-6533
Mailing Address - Fax:
Practice Address - Street 1:82 BUCK RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:18966-1751
Practice Address - Country:US
Practice Address - Phone:215-280-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional