Provider Demographics
NPI:1124638713
Name:REYNOSA, TESSA EMILY (MFT)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:EMILY
Last Name:REYNOSA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:832 FOLSOM ST STE 702
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-4502
Mailing Address - Country:US
Mailing Address - Phone:415-715-1050
Mailing Address - Fax:
Practice Address - Street 1:832 FOLSOM ST STE 702
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94107-4502
Practice Address - Country:US
Practice Address - Phone:415-715-1050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-07
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist