Provider Demographics
NPI:1033948187
Name:TELILA, MULU N (MEDICAL MASSAGE PRAC)
Entity type:Individual
Prefix:
First Name:MULU
Middle Name:N
Last Name:TELILA
Suffix:
Gender:F
Credentials:MEDICAL MASSAGE PRAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SUNNY CREEK LN
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-5828
Mailing Address - Country:US
Mailing Address - Phone:817-938-7135
Mailing Address - Fax:
Practice Address - Street 1:1101 SUNNY CREEK LN
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-5828
Practice Address - Country:US
Practice Address - Phone:817-938-7135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT024057101200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101200000XBehavioral Health & Social Service ProvidersDrama Therapist