Healthcare Provider Details

I. General information

NPI: 1972449130
Provider Name (Legal Business Name): MICHAEL TEKELLY LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 KINDERKAMACK RD STE 2D
EMERSON NJ
07630-1854
US

IV. Provider business mailing address

381 KAPLAN AVE
HACKENSACK NJ
07601-1837
US

V. Phone/Fax

Practice location:
  • Phone: 201-546-5634
  • Fax:
Mailing address:
  • Phone: 201-575-9458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01033200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: