Healthcare Provider Details

I. General information

NPI: 1760473474
Provider Name (Legal Business Name): TELIA TERESA KITELEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 N 31ST AVE A-105
PHOENIX AZ
85051-9582
US

IV. Provider business mailing address

10000 N 31ST AVE A-105
PHOENIX AZ
85051-9582
US

V. Phone/Fax

Practice location:
  • Phone: 602-843-0000
  • Fax: 602-997-1305
Mailing address:
  • Phone: 602-843-0000
  • Fax: 602-997-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC0328
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: