Healthcare Provider Details

I. General information

NPI: 1508983453
Provider Name (Legal Business Name): TESSA GRAHAM MS, MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2007
Last Update Date: 06/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 VARIEL AVE STE A
WOODLAND HILLS CA
91367-2514
US

IV. Provider business mailing address

6340 VARIEL AVE STE A
WOODLAND HILLS CA
91367-2514
US

V. Phone/Fax

Practice location:
  • Phone: 818-888-4559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC39945
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: