Provider Demographics
NPI:1902335268
Name:TELLO, ARLEEN CAROL (CATC II, RAS IIII,)
Entity Type:Individual
Prefix:
First Name:ARLEEN
Middle Name:CAROL
Last Name:TELLO
Suffix:
Gender:F
Credentials:CATC II, RAS IIII,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 HULEN PL
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-2606
Mailing Address - Country:US
Mailing Address - Phone:951-595-4133
Mailing Address - Fax:
Practice Address - Street 1:2880 HULEN PLACE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-595-4133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1710580101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)