Provider Demographics
NPI:1174172357
Name:TELLO, SARAH MARGARET (LEP)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARGARET
Last Name:TELLO
Suffix:
Gender:F
Credentials:LEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4588 GUAVA AVE
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-2940
Mailing Address - Country:US
Mailing Address - Phone:562-252-5578
Mailing Address - Fax:
Practice Address - Street 1:4588 GUAVA AVE
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-2940
Practice Address - Country:US
Practice Address - Phone:562-252-5578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP3947103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool