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NPI Code Detail

MEDICARE: KEYLEE ANN TESAR MS LPC

MEDICARE:   KEYLEE ANN TESAR  MS LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor4154OK

General Provider Information

NPI Number : 1013248087
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEYLEE ANN TESAR MS LPC
Provider Business Mailing Address
First Line : 1601 OLD SOUTH RIVER RD
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-4120
Country : US
Telephone Number : 636-224-1210
Fax Number : 636-246-1008
Provider Business Practice Location Address
First Line : 6440 S LEWIS AVE STE 2200
Second Line :
City : TULSA
State : OK
Zip : 74136-1060
Country : US
Telephone Number : 918-388-6457
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2010
Last Update Date : 04/23/2024

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1538348602 — ERICA DANIELLE DONALDSON MS, LPC
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Directions to “ KEYLEE ANN TESAR MS LPC” Practice Location

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