Provider Demographics
NPI:1639488208
Name:CESSNA, TAHRA JOLENE (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:TAHRA
Middle Name:JOLENE
Last Name:CESSNA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SE HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5925
Mailing Address - Country:US
Mailing Address - Phone:772-284-1391
Mailing Address - Fax:
Practice Address - Street 1:660 NE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-1623
Practice Address - Country:US
Practice Address - Phone:772-284-1391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst