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NPI Code Detail

MEDICARE: JESSICA MARIE MIX-TESMER LMFT

MEDICARE: JESSICA MARIE MIX-TESMER LMFT
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
1106H00000XMarriage & Family Therapist01199NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205149044
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA MARIE MIX-TESMER LMFT
Provider Business Mailing Address
First Line : 8414 FARM RD
Second Line : STE 180377
City : LAS VEGAS
State : NV
Zip : 89131-8170
Country : US
Telephone Number : 702-998-2816
Fax Number : 702-998-2991
Provider Business Practice Location Address
First Line : 6390 W CHEYENNE AVE
Second Line : STE C
City : LAS VEGAS
State : NV
Zip : 89108-6009
Country : US
Telephone Number : 702-673-7796
Fax Number : 866-611-8528
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2010
Last Update Date : 02/26/2021

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