Healthcare Provider Details

I. General information

NPI: 1104566371
Provider Name (Legal Business Name): TESSA TONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6460 CENTERVILLE BUSINESS PKWY
CENTERVILLE OH
45459-2633
US

IV. Provider business mailing address

6460 CENTERVILLE BUSINESS PKWY
CENTERVILLE OH
45459-2633
US

V. Phone/Fax

Practice location:
  • Phone: 937-723-6453
  • Fax: 775-392-1245
Mailing address:
  • Phone: 937-723-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCOBA.01478
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: