Provider Demographics
NPI:1992119044
Name:DEBORAH A. TELAAK, LMHC
Entity type:Organization
Organization Name:DEBORAH A. TELAAK, LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:TELAAK
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:716-638-0003
Mailing Address - Street 1:29 BUCYRUS DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-1944
Mailing Address - Country:US
Mailing Address - Phone:716-691-8913
Mailing Address - Fax:716-691-7013
Practice Address - Street 1:100 CORPORATE PKWY STE 318
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-1200
Practice Address - Country:US
Practice Address - Phone:716-638-0003
Practice Address - Fax:716-691-7013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002528251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health