Provider Demographics
NPI:1588202584
Name:STINE, TESSA (MCMHC, CPC, I)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:STINE
Suffix:
Gender:F
Credentials:MCMHC, CPC, I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 MARK AVE
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-3815
Mailing Address - Country:US
Mailing Address - Phone:717-439-6327
Mailing Address - Fax:
Practice Address - Street 1:415 US HIGHWAY 95A S
Practice Address - Street 2:
Practice Address - City:FERNLEY
Practice Address - State:NV
Practice Address - Zip Code:89408-9261
Practice Address - Country:US
Practice Address - Phone:775-575-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health