Provider Demographics
NPI:1699568816
Name:TEFFETELLER, ARIEL (LMSW)
Entity type:Individual
Prefix:
First Name:ARIEL
Middle Name:
Last Name:TEFFETELLER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 TOBIN CT
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97527-5252
Mailing Address - Country:US
Mailing Address - Phone:562-852-7550
Mailing Address - Fax:
Practice Address - Street 1:1314 TOBIN CT
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97527-5252
Practice Address - Country:US
Practice Address - Phone:562-852-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORM15920101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health