Provider Demographics
NPI:1013200815
Name:KESSINGER, TAMMY SUE
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:SUE
Last Name:KESSINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 W HORIZON RIDGE PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5082
Mailing Address - Country:US
Mailing Address - Phone:702-294-0433
Mailing Address - Fax:
Practice Address - Street 1:375 N STEPHANIE ST STE 811
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-8725
Practice Address - Country:US
Practice Address - Phone:702-294-0433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP1282-R101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM171M00000XMedicaid