Provider Demographics
NPI:1659039154
Name:TELLEZ, ALEXANDRA (PHD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18615 BRIDLE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-2555
Mailing Address - Country:US
Mailing Address - Phone:832-792-3212
Mailing Address - Fax:
Practice Address - Street 1:1200 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-1962
Practice Address - Country:US
Practice Address - Phone:713-222-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37130103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty