Provider Demographics
NPI:1568852531
Name:TESFA, LIALA
Entity Type:Individual
Prefix:
First Name:LIALA
Middle Name:
Last Name:TESFA
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 1:3333 NAAMAN SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-8717
Mailing Address - Country:US
Mailing Address - Phone:972-273-0256
Mailing Address - Fax:469-519-4376
Practice Address - Street 1:3333 NAAMAN SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-8717
Practice Address - Country:US
Practice Address - Phone:972-273-0256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-29
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2557103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty