MEDICARE: TELSTONE IOP, LLC

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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1326790965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TELSTONE IOP, LLC

Provider Business Mailing Address
First Line	:	1401 FORUM WAY STE 500
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-2322
Country	:	US
Telephone Number	:	561-900-0003
Fax Number	:

Provider Business Practice Location Address
First Line	:	1401 FORUM WAY STE 500
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-2322
Country	:	US
Telephone Number	:	561-900-0003
Fax Number	:

Authorized Official
Title or Position	:	CHIEF ADMINISTRATIVE OFFICER
Name	:	LYNDSEY MCMILLAN
Credential	:
Telephone Number	:	561-900-0003

Provider Enumeration Date	:	01/25/2022
Last Update Date	:	02/10/2022

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