Healthcare Provider Details

I. General information

NPI: 1346453867
Provider Name (Legal Business Name): TESSA J JOHNSTON MA, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 COORS BLVD NW STE 203
ALBUQUERQUE NM
87120-1207
US

IV. Provider business mailing address

4802 SAN TIMOTEO AVE NW
ALBUQUERQUE NM
87114-3833
US

V. Phone/Fax

Practice location:
  • Phone: 505-977-1152
  • Fax:
Mailing address:
  • Phone: 505-977-1152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0198971
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: