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General NPI Number Information
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NPI Number | 1477260446
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Entity Type | Individual
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Provider Name | TESSA R GROOMS LMSW
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Gender | Female
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Dates
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Enumeration Date | 10/31/2022
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 19645 N 31ST AVE
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City | PHOENIX
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State | AZ
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Zip | 85027-3984
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Country | US
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Telephone | 740-406-8993
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Fax |
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Provider Business Mailing Address
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Address Line | 2111 E BASELINE RD STE A2
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City | TEMPE
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State | AZ
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Zip | 85283-1505
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Country | US
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Telephone | 480-489-3925
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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 | LMSW-20870
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License Number State | AZ
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