MEDICARE: TESSA HEUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency		OH

General Provider Information

NPI Number	:	1861881245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSA HEUNG

Provider Business Mailing Address
First Line	:	1330 WEST BLVD APT 223
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-1748
Country	:	US
Telephone Number	:	808-228-0499
Fax Number	:

Provider Business Practice Location Address
First Line	:	1330 WEST BLVD APT 223
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44102-1748
Country	:	US
Telephone Number	:	808-228-0499
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2015
Last Update Date	:	01/22/2015

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Directions to “ TESSA HEUNG ” Practice Location

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