Healthcare Provider Details

I. General information

NPI: 1467692574
Provider Name (Legal Business Name): TESSA BREANN PRICE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 PARKCENTRE WAY STE 7
NAMPA ID
83651-1748
US

IV. Provider business mailing address

915 PARKCENTRE WAY STE 7
NAMPA ID
83651-1748
US

V. Phone/Fax

Practice location:
  • Phone: 208-442-7791
  • Fax:
Mailing address:
  • Phone: 208-442-7791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-4968
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: