Healthcare Provider Details

I. General information

NPI: 1790424794
Provider Name (Legal Business Name): TESS ANDERSON APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 W OLYMPIC BLVD
LOS ANGELES CA
90064-1151
US

IV. Provider business mailing address

11900 W OLYMPIC BLVD
LOS ANGELES CA
90064-1151
US

V. Phone/Fax

Practice location:
  • Phone: 888-225-1995
  • Fax: 213-527-6510
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2366453
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95022269
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number825517
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number172978
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: