Provider Demographics
NPI:1518043835
Name:TESSLER, STEPHEN WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:WAYNE
Last Name:TESSLER
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 1:125 N LINCOLN ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-3258
Mailing Address - Country:US
Mailing Address - Phone:530-758-4447
Mailing Address - Fax:530-758-9246
Practice Address - Street 1:125 N LINCOLN ST
Practice Address - Street 2:SUITE H
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3258
Practice Address - Country:US
Practice Address - Phone:530-758-4447
Practice Address - Fax:530-758-9246
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist