Provider Demographics
NPI:1710678883
Name:TAKEHARA, TESSIE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:TESSIE
Middle Name:
Last Name:TAKEHARA
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2877 CHILDRESS DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:CA
Mailing Address - Zip Code:96007-3563
Mailing Address - Country:US
Mailing Address - Phone:530-360-4884
Mailing Address - Fax:
Practice Address - Street 1:2877 CHILDRESS DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:CA
Practice Address - Zip Code:96007-3563
Practice Address - Country:US
Practice Address - Phone:530-360-4884
Practice Address - Fax:530-356-2902
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-52722103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst