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General NPI Number Information
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NPI Number | 1649413048
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Entity Type | Individual
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Provider Name | THEODORE C TESSIER LMFT, LADC
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Gender | Male
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Dates
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Enumeration Date | 04/14/2009
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Last Update Date | 05/20/2015
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Provider Practice Location Address
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Address Line | 1900 SILVER LAKE RD NW SUITE 110
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-1786
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Country | US
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Telephone | 651-628-9566
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Fax |
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Provider Business Mailing Address
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Address Line | 935 SHERREN ST W
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City | SAINT PAUL
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State | MN
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Zip | 55113-4408
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Country | US
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Telephone | 651-324-9364
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1925
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 303150
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License Number State | MN
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