MEDICARE: ADEGBITE ADEGBOYE TELLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1033887260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADEGBITE ADEGBOYE TELLA

Provider Business Mailing Address
First Line	:	972 TERRACE LAKE DR
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8976
Country	:	US
Telephone Number	:	331-300-9793
Fax Number	:

Provider Business Practice Location Address
First Line	:	972 TERRACE LAKE DR
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60504-8976
Country	:	US
Telephone Number	:	331-300-9793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2021
Last Update Date	:	09/02/2021

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Directions to “ ADEGBITE ADEGBOYE TELLA ” Practice Location

Language	Start Address	Practice Location

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