1003485210 NPI number — LAURA ARACELY TELLEZ MSW, LCSW

Table of content: LAURA ARACELY TELLEZ MSW, LCSW (NPI 1003485210)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003485210 NPI number — LAURA ARACELY TELLEZ MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TELLEZ
Provider First Name:
LAURA
Provider Middle Name:
ARACELY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003485210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13333 DOTSON RD STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77070-4305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
346-206-3992
Provider Business Mailing Address Fax Number:
832-652-3626

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12234 SHADOW CREEK PARKWAY, BLDG 10
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
346-206-3992
Provider Business Practice Location Address Fax Number:
832-652-3626
Provider Enumeration Date:
06/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  55864 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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