Provider Demographics
NPI:1982610523
Name:TELLEZ, TERESA C (LCSW LMP)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:C
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:LCSW LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:15 S GRADY WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-3220
Mailing Address - Country:US
Mailing Address - Phone:425-255-5554
Mailing Address - Fax:425-228-8029
Practice Address - Street 1:15 S GRADY WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-3220
Practice Address - Country:US
Practice Address - Phone:425-255-5554
Practice Address - Fax:425-228-8029
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000063091041C0700X
WAMA00005101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist