Healthcare Provider Details

I. General information

NPI: 1164432118
Provider Name (Legal Business Name): TELLURIAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 08/15/2022
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1053 WILLIAMSON ST
MADISON WI
53703-3525
US

IV. Provider business mailing address

1053 WILLIAMSON ST
MADISON WI
53703-3525
US

V. Phone/Fax

Practice location:
  • Phone: 608-258-3446
  • Fax: 608-258-3445
Mailing address:
  • Phone: 608-258-3446
  • Fax: 608-258-3445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ERICA L MUELLER
Title or Position: QUALITY ASSURANCE DIRECTOR
Credential:
Phone: 608-204-8547