Provider Demographics
NPI:1558465047
Name:TESAR, VIM L (MS, LCPC, LAC, CRC)
Entity Type:Individual
Prefix:MS
First Name:VIM
Middle Name:L
Last Name:TESAR
Suffix:
Gender:F
Credentials:MS, LCPC, LAC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 1ST AVE E STE 7
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4965
Mailing Address - Country:US
Mailing Address - Phone:406-752-5211
Mailing Address - Fax:406-752-7072
Practice Address - Street 1:307 1ST AVE E STE 7
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4965
Practice Address - Country:US
Practice Address - Phone:406-752-5211
Practice Address - Fax:406-752-7072
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT789101YA0400X
MT728101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT742100OtherBCBS
MT0256659Medicaid