Provider Demographics
NPI:1740400530
Name:TESSMER, DONALD O (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:O
Last Name:TESSMER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4640 GLENCOE AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6388
Mailing Address - Country:US
Mailing Address - Phone:310-827-4307
Mailing Address - Fax:
Practice Address - Street 1:10436 SANTA MONICA BLVD
Practice Address - Street 2:3005
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6933
Practice Address - Country:US
Practice Address - Phone:310-393-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALEP103T00000X
CALEP 1817103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool