Provider Demographics
NPI:1669854857
Name:COOLEY, TATESSICA (MA)
Entity Type:Individual
Prefix:MS
First Name:TATESSICA
Middle Name:
Last Name:COOLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9641 NORCHESTER CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1849
Mailing Address - Country:US
Mailing Address - Phone:601-342-1017
Mailing Address - Fax:
Practice Address - Street 1:7403 TEMPLE TERRACE HIGHWAY
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637
Practice Address - Country:US
Practice Address - Phone:813-399-4605
Practice Address - Fax:813-899-4688
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14939101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020519000Medicaid
FL020601200Medicaid