Provider Demographics
NPI:1942582614
Name:DAHL, TESA T (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:TESA
Middle Name:T
Last Name:DAHL
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 1:105 CANCHA DE GOLF
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92091-4568
Mailing Address - Country:US
Mailing Address - Phone:619-203-7447
Mailing Address - Fax:
Practice Address - Street 1:1137 CAMINO DEL MAR
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-2605
Practice Address - Country:US
Practice Address - Phone:619-203-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-2050103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst