Healthcare Provider Details

I. General information

NPI: 1013139294
Provider Name (Legal Business Name): KATHRYN VERONICA TESSMER MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 VACA VALLEY PKWY
VACAVILLE CA
95688-9430
US

IV. Provider business mailing address

3413 OYSTER BAY AVE
DAVIS CA
95616-5603
US

V. Phone/Fax

Practice location:
  • Phone: 707-453-5921
  • Fax: 707-453-2993
Mailing address:
  • Phone: 530-792-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number18635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: