Provider Demographics
NPI:1326494865
Name:BURRIS, TESSA (LPC)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:BURRIS
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 1:2650 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-4322
Mailing Address - Country:US
Mailing Address - Phone:405-206-2808
Mailing Address - Fax:
Practice Address - Street 1:2650 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-4322
Practice Address - Country:US
Practice Address - Phone:405-206-2808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6649101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health