Provider Demographics
NPI:1376761064
Name:TELKER, JOSEPH WILLIAM (MSPS, LPC, UNDER SUP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:WILLIAM
Last Name:TELKER
Suffix:
Gender:M
Credentials:MSPS, LPC, UNDER SUP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 HEBBERT ST
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74344-2700
Mailing Address - Country:US
Mailing Address - Phone:573-944-3838
Mailing Address - Fax:
Practice Address - Street 1:1107 E 13TH ST
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344-7955
Practice Address - Country:US
Practice Address - Phone:918-787-8744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100734620-BMedicaid
OK100734620-DMedicaid