=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073142444
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TESSA GITTLEMAN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2020
-----------------------------------------------------
Last Update Date | 12/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5851 DULUTH ST UNIT 300
-----------------------------------------------------
City | GOLDEN VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55422-3946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-440-8377
-----------------------------------------------------
Fax | 612-440-2187
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5851 DULUTH ST UNIT 300
-----------------------------------------------------
City | GOLDEN VALLEY
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55422-3946
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-440-8377
-----------------------------------------------------
Fax | 612-440-2187
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 3573
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------