Provider Demographics
NPI:1932751682
Name:TELEP, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TELEP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 N PINON CIR
Mailing Address - Street 2:
Mailing Address - City:BAYFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:81122-9658
Mailing Address - Country:US
Mailing Address - Phone:970-946-7098
Mailing Address - Fax:
Practice Address - Street 1:1327 BAYFIELD PARKWAY, SUITE A
Practice Address - Street 2:
Practice Address - City:BAYFIELD
Practice Address - State:CO
Practice Address - Zip Code:81122
Practice Address - Country:US
Practice Address - Phone:970-844-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health