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1245776756
JERREL TELLIS
SHREVEPORT, LA
NPI
1245776756
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
171M00000X Case Manager/Care Coordinator
Additional Taxonomies
101YM0800X Counselor, Mental Health
Enumeration Date
2017-01-09
Last Update Date
2018-09-11
Business Address
JERREL TELLIS
2715 MACKEY PL STE 15
SHREVEPORT, LA 71118-2544
Phone number: 318-220-8423
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Mailing Address
JERREL TELLIS
2715 MACKEY PL STE 15
SHREVEPORT, LA 71118-2544
Phone number: 318-220-8423
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