Provider Demographics
NPI:1114535085
Name:SANDS, TESSA JOY
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:JOY
Last Name:SANDS
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 1:3242 HOFFMAN HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:DUPONT
Mailing Address - State:WA
Mailing Address - Zip Code:98327-8740
Mailing Address - Country:US
Mailing Address - Phone:949-395-5450
Mailing Address - Fax:
Practice Address - Street 1:2002 65TH AVE W
Practice Address - Street 2:
Practice Address - City:FIRCREST
Practice Address - State:WA
Practice Address - Zip Code:98466-6200
Practice Address - Country:US
Practice Address - Phone:253-566-5559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health