Healthcare Provider Details

I. General information

NPI: 1780251801
Provider Name (Legal Business Name): TESSA WOLFORD LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 12/01/2024
Certification Date: 12/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 WAYZATA BLVD STE 200
ST LOUIS PARK MN
55416-1338
US

IV. Provider business mailing address

279 N WILLIS ST STE C
ABILENE TX
79603-6993
US

V. Phone/Fax

Practice location:
  • Phone: 612-924-3807
  • Fax:
Mailing address:
  • Phone: 325-261-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number82641
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: