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NPI Code Detail

MEDICARE: TESSA PATTERSON LCDC

MEDICARE:   TESSA  PATTERSON  LCDC
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
1101YA0400XAddiction (Substance Use Disorder) Counselor49764TX
2101YA0400XAddiction (Substance Use Disorder) Counselor16022TX

General Provider Information

NPI Number : 1114692217
Entity Type Code : Individual
Provider Name (Legal Business Name) : TESSA PATTERSON LCDC
Provider Business Mailing Address
First Line : 7535 OAKMONT BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4236
Country : US
Telephone Number : 826-367-2053
Fax Number :
Provider Business Practice Location Address
First Line : 7535 OAKMONT BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76132-4236
Country : US
Telephone Number : 682-367-2053
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2021
Last Update Date : 02/03/2023

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Directions to “ TESSA PATTERSON LCDC” Practice Location

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