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NPI Code Detail

MEDICARE: MS. AMY H TELLER LPC

MEDICARE: MS. AMY H TELLER LPC
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
1101YP2500XProfessional CounselorLPC002123GA

General Provider Information

NPI Number : 1942404991
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMY H TELLER LPC
Provider Business Mailing Address
First Line : 125 ROSWELL FARMS LANE
Second Line :
City : ROSWELL
State : GA
Zip : 30075-4312
Country : US
Telephone Number : 404-626-4187
Fax Number :
Provider Business Practice Location Address
First Line : 2697 SANDY PLAINS RD
Second Line :
City : MARIETTA
State : GA
Zip : 30066-4256
Country : US
Telephone Number : 770-998-3595
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2007
Last Update Date : 07/08/2007

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Directions to “ MS. AMY H TELLER LPC” Practice Location

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