Basic Information
| Provider Information | |||||||||
| NPI: | 1003291238 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TESSLER | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7301 INDIAN SCHOOL RD NE STE A | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871104504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052660441 | ||||||||
| FaxNumber: | 5052660504 | ||||||||
| Practice Location | |||||||||
| Address1: | 7301 INDIAN SCHOOL RD NE STE A | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871104504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052660441 | ||||||||
| FaxNumber: | 5052660504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2015 | ||||||||
| LastUpdateDate: | 01/02/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 01/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW72938 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 87154 | CA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 225400000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Practitioner | 1041C0700X | C-11070 | NM | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.