Provider Demographics
NPI:1760160592
Name:TLC TELEHEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:TLC TELEHEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAVARE
Authorized Official - Middle Name:
Authorized Official - Last Name:SELTUN
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:980-745-2195
Mailing Address - Street 1:4324 STONE MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0007
Mailing Address - Country:US
Mailing Address - Phone:980-745-2195
Mailing Address - Fax:
Practice Address - Street 1:4324 STONE MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0007
Practice Address - Country:US
Practice Address - Phone:980-745-2195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty