MEDICARE: MS. TELIA TERESA KITELEY LPC

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	101YP2500X	Professional Counselor	LPC0328	AZ

General Provider Information

NPI Number	:	1760473474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TELIA TERESA KITELEY LPC

Provider Business Mailing Address
First Line	:	10000 N 31ST AVE
Second Line	:	A-105
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9582
Country	:	US
Telephone Number	:	602-843-0000
Fax Number	:	602-997-1305

Provider Business Practice Location Address
First Line	:	10000 N 31ST AVE
Second Line	:	A-105
City	:	PHOENIX
State	:	AZ
Zip	:	85051-9582
Country	:	US
Telephone Number	:	602-843-0000
Fax Number	:	602-997-1305

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	05/06/2009

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