Provider Demographics
NPI:1114952595
Name:TESS, STEVEN REINHOLD (PHD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:REINHOLD
Last Name:TESS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FESLER ST.
Mailing Address - Street 2:STE. 205
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1946
Mailing Address - Country:US
Mailing Address - Phone:619-579-9346
Mailing Address - Fax:619-579-9304
Practice Address - Street 1:500 FESLER ST.
Practice Address - Street 2:STE. 205
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-1946
Practice Address - Country:US
Practice Address - Phone:619-579-9346
Practice Address - Fax:619-579-9304
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8938103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPG0089380Medicaid
CACP8938Medicare PIN
CAPG0089380Medicaid