Provider Demographics
NPI:1811307960
Name:TELZEROW, REBECCA (MA LLPC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:TELZEROW
Suffix:
Gender:F
Credentials:MA LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2305 EAST PARIS AVE SE STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-2426
Mailing Address - Country:US
Mailing Address - Phone:616-914-6925
Mailing Address - Fax:
Practice Address - Street 1:2305 EAST PARIS AVE SUITE 203
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-914-6925
Practice Address - Fax:866-496-2998
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health