Provider Demographics
NPI:1265741185
Name:TELLEZ, MARY ELIZABETH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:TELLEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:902 MCCLAIN RD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-9241
Mailing Address - Country:US
Mailing Address - Phone:214-636-6766
Mailing Address - Fax:
Practice Address - Street 1:32 TAVISTOCK DR
Practice Address - Street 2:
Practice Address - City:BELLA VISTA
Practice Address - State:AR
Practice Address - Zip Code:72714-3502
Practice Address - Country:US
Practice Address - Phone:214-636-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-27
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8522-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical