Healthcare Provider Details

I. General information

NPI: 1588377881
Provider Name (Legal Business Name): TESSA MARGARET KOZIOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2023
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4955 ALTA ST
SIMI VALLEY CA
93063-2452
US

IV. Provider business mailing address

14505 LOYOLA ST
MOORPARK CA
93021-1316
US

V. Phone/Fax

Practice location:
  • Phone: 805-791-3725
  • Fax:
Mailing address:
  • Phone: 818-437-6492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number14698
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number14698
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: