Provider Demographics
NPI:1447520465
Name:TELANDER, JAMES E (PSYD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
Last Name:TELANDER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7650 S. NEWCASTLE RD.
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95215
Mailing Address - Country:US
Mailing Address - Phone:209-546-4265
Mailing Address - Fax:
Practice Address - Street 1:7650 S. NEWCASTLE RD.
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95215
Practice Address - Country:US
Practice Address - Phone:209-546-4265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15730103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical