Provider Demographics
NPI:1043588577
Name:TESORO, JOSEPH MICHAEL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:TESORO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-1220
Mailing Address - Country:US
Mailing Address - Phone:323-652-2339
Mailing Address - Fax:323-254-9087
Practice Address - Street 1:1910 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-1220
Practice Address - Country:US
Practice Address - Phone:323-652-2339
Practice Address - Fax:323-254-9087
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF68411106H00000X
CALMFT83968106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist