Provider Demographics
NPI:1144619859
Name:SICBLE, TESSA RAE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TESSA
Middle Name:RAE
Last Name:SICBLE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SLATE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6171
Mailing Address - Country:US
Mailing Address - Phone:701-751-0302
Mailing Address - Fax:
Practice Address - Street 1:101 SLATE DR STE 2
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6171
Practice Address - Country:US
Practice Address - Phone:701-751-0302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND81811515A101YM0800X
ND818-1-15-15101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health