Basic Information
Provider Information
NPI: 1003291238
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TESSLER
FirstName: KATHERINE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/02/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XASW72938CAN Behavioral Health & Social Service ProvidersCounselorMental Health
1041C0700XC-11070NMY Behavioral Health & Social Service ProvidersSocial WorkerClinical
1041C0700X87154CAN Behavioral Health & Social Service ProvidersSocial WorkerClinical
225400000X  N Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner 

No ID Information.


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