Provider Demographics
NPI:1093391831
Name:TESSA G INC.
Entity Type:Organization
Organization Name:TESSA G INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLIBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-444-7074
Mailing Address - Street 1:PO BOX 7032
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VLG
Mailing Address - State:CA
Mailing Address - Zip Code:91359-7032
Mailing Address - Country:US
Mailing Address - Phone:805-444-7074
Mailing Address - Fax:
Practice Address - Street 1:5798 OAK BANK TRL UNIT 105
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-5631
Practice Address - Country:US
Practice Address - Phone:805-444-7074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty