| Tellurian, Inc. | |
|
300 Femrite Dr Monona WI 53716-3716 | |
| (608) 222-7311 | |
| (608) 222-5904 |
| Full Name | Tellurian, Inc. |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 300 Femrite Dr, Monona, Wisconsin |
| Authorized Official Name and Position | Erica L Mueller (QUALITY ASSURANCE DIRECTOR) |
| Authorized Official Contact | 9143166601 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tellurian, Inc. 300 Femrite Dr Monona WI 53716-3716 Ph: (608) 222-7311 | Tellurian, Inc. 300 Femrite Dr Monona WI 53716-3716 Ph: (608) 222-7311 |
| NPI Number | 1740213776 |
|---|---|
| Provider Enumeration Date | 07/10/2006 |
| Last Update Date | 08/15/2022 |
| Certification Date | 01/05/2021 |
| Medicare PECOS PAC ID | 6204925365 |
|---|---|
| Medicare Enrollment ID | O20071128000134 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740213776 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Brian E Lochen |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1235119413 PECOS PAC ID: 1052389517 Enrollment ID: I20040922000518 |
| Provider Name | Randall K Cullen |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1255368346 PECOS PAC ID: 4486689015 Enrollment ID: I20051003000031 |
| Provider Name | Samkhann Mak |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750307815 PECOS PAC ID: 6507876075 Enrollment ID: I20060427000536 |
| Provider Name | Beth A Blakeslee |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1528135795 PECOS PAC ID: 1557450616 Enrollment ID: I20071128000152 |
| Provider Name | William R Mcauliffe Schroeder |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275723504 PECOS PAC ID: 4082892443 Enrollment ID: I20110707000327 |
| Provider Name | Gina M Bryan |
|---|---|
| Provider Type | Practitioner - Certified Clinical Nurse Specialist (cns) |
| Provider Identifiers | NPI Number: 1558578450 PECOS PAC ID: 7810125192 Enrollment ID: I20140113000787 |
| Provider Name | Diane Marie Kelley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326414442 PECOS PAC ID: 6507176161 Enrollment ID: I20151111000270 |
| Provider Name | Jason G Meir |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1437672318 PECOS PAC ID: 5991144081 Enrollment ID: I20240423001316 |
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