Provider Demographics
NPI:1235525197
Name:TESSIEN, MAKHETSI (LMFT)
Entity Type:Individual
Prefix:
First Name:MAKHETSI
Middle Name:
Last Name:TESSIEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 135
Mailing Address - Street 2:
Mailing Address - City:WOODACRE
Mailing Address - State:CA
Mailing Address - Zip Code:94973-0135
Mailing Address - Country:US
Mailing Address - Phone:510-473-8841
Mailing Address - Fax:
Practice Address - Street 1:45 SAN CLEMENTE DR STE D230B
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1296
Practice Address - Country:US
Practice Address - Phone:510-473-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CALMFT117209106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program