Provider Demographics
NPI:1114692217
Name:PATTERSON, TESSA (LCDC)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:KRUGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7535 OAKMONT BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-4236
Mailing Address - Country:US
Mailing Address - Phone:826-367-2053
Mailing Address - Fax:
Practice Address - Street 1:7535 OAKMONT BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-4236
Practice Address - Country:US
Practice Address - Phone:682-367-2053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-11
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49764101YA0400X
TX16022101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)