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General NPI Number Information
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NPI Number | 1467141556
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Entity Type | Individual
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Provider Name | DESIREE NICOLE TENNISON LMSW
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Gender | Female
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/03/2023
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Provider Practice Location Address
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Address Line | 5304 W PLANO PKWY
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City | PLANO
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State | TX
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Zip | 75093-4821
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Country | US
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Telephone | 972-962-9038
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Fax |
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Provider Business Mailing Address
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Address Line | 4204 DUBLIN RIDGE DR
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City | CROWLEY
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State | TX
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Zip | 76036-8923
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Country | US
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Telephone | 817-714-3703
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 105631
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 105631
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License Number State | TX
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