Provider Demographics
NPI:1134265184
Name:TELLEZ-PALMER, MONICA (MED)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:TELLEZ-PALMER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N. CLASSEN BLVD.
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-6699
Mailing Address - Country:US
Mailing Address - Phone:405-524-0969
Mailing Address - Fax:405-523-3015
Practice Address - Street 1:1501 N. CLASSEN BLVD.
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106
Practice Address - Country:US
Practice Address - Phone:405-524-0969
Practice Address - Fax:405-523-3015
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1301101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional