Provider Demographics
NPI:1225699663
Name:WILLIAMS, TESSA JUDY
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:JUDY
Last Name:WILLIAMS
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 1:115 CHAMBERS LN
Mailing Address - Street 2:
Mailing Address - City:MARKLEEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96120-9660
Mailing Address - Country:US
Mailing Address - Phone:775-781-7814
Mailing Address - Fax:
Practice Address - Street 1:333 ABBOTT ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4485
Practice Address - Country:US
Practice Address - Phone:530-578-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43950298103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst