Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ASW72938 | CA |
N | 1041C0700X | Clinical Social Worker | 87154 | CA |
Y | 1041C0700X | Clinical Social Worker | C-11070 | NM |
N | 225400000X | Rehabilitation Practitioner |
NPI | 1003291238 |
---|---|
Provider Name | Katherine Tessler |
First Address | Albuquerque, NM 87110-4504 |
Second Address | Albuquerque, NM 87110-4504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2015 |
Last Update Date | 02/01/2020 |