Healthcare Provider Details

I. General information

NPI: 1780022178
Provider Name (Legal Business Name): TESSA BREE COSAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25847 VAN LEUVEN ST APT 188
LOMA LINDA CA
92354-2558
US

IV. Provider business mailing address

25847 VAN LEUVEN ST APT 188
LOMA LINDA CA
92354-2558
US

V. Phone/Fax

Practice location:
  • Phone: 425-736-7120
  • Fax:
Mailing address:
  • Phone: 425-736-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number11182
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number11182
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: