Provider Demographics
NPI:1538735485
Name:TELLO, ADAN EINER (MFT ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ADAN
Middle Name:EINER
Last Name:TELLO
Suffix:
Gender:M
Credentials:MFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 S MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3923
Mailing Address - Country:US
Mailing Address - Phone:760-241-6044
Mailing Address - Fax:
Practice Address - Street 1:851 S MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3923
Practice Address - Country:US
Practice Address - Phone:760-241-6044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123283101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health