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General NPI Number Information
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NPI Number | 1922165802
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Entity Type | Individual
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Provider Name | TSEGAMLAK TELEALE WORKU M.F.T.
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1000 E WALNUT ST SUITE 115
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City | PASADENA
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State | CA
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Zip | 91106-1452
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Country | US
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Telephone | 626-786-1019
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Fax | 626-628-3638
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Provider Business Mailing Address
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Address Line | 1000 E WALNUT ST SUITE 115
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City | PASADENA
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State | CA
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Zip | 91106-1452
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Country | US
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Telephone | 626-786-1019
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Fax | 626-628-3638
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 37565
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License Number State | CA
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