Provider Demographics
NPI:1902606940
Name:TELLEZ, ALAN
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:TELLEZ
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:XOCHIQUETZAL
Other - Middle Name:
Other - Last Name:TELLEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2615 S 58TH CT
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-3218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2615 S 58TH CT
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-3218
Practice Address - Country:US
Practice Address - Phone:708-469-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician