Healthcare Provider Details

I. General information

NPI: 1003291238
Provider Name (Legal Business Name): KATHERINE TESSLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 INDIAN SCHOOL RD NE STE A
ALBUQUERQUE NM
87110-4504
US

IV. Provider business mailing address

7301 INDIAN SCHOOL RD NE STE A
ALBUQUERQUE NM
87110-4504
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-0441
  • Fax: 505-266-0504
Mailing address:
  • Phone: 505-266-0441
  • Fax: 505-266-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW72938
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number87154
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-11070
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: