Provider Demographics
NPI:1740656685
Name:TELLECHEA, PAUL (LMHC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:TELLECHEA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 PONCE DE LEON BLVD
Mailing Address - Street 2:APT 2
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7317
Mailing Address - Country:US
Mailing Address - Phone:305-412-0138
Mailing Address - Fax:305-412-0140
Practice Address - Street 1:7811 CORAL WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6540
Practice Address - Country:US
Practice Address - Phone:305-412-0138
Practice Address - Fax:305-412-0140
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-14
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH13329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health