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General NPI Number Information
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NPI Number | 1093391831
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Entity Type | Organization
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Legal Business Name | TESSA G INC.
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 03/22/2021
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Provider Practice Location Address
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Address Line | 5798 OAK BANK TRL UNIT 105
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City | OAK PARK
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State | CA
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Zip | 91377-5631
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Country | US
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Telephone | 805-444-7074
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 7032
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City | WESTLAKE VLG
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State | CA
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Zip | 91359-7032
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Country | US
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Telephone | 805-444-7074
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | THERESA GILLIBRAND
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Credential |
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Telephone | 805-444-7074
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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