Provider Demographics
NPI:1205149044
Name:MIX-TESMER, JESSICA MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:MIX-TESMER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 FARM RD
Mailing Address - Street 2:STE 180377
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8170
Mailing Address - Country:US
Mailing Address - Phone:702-998-2816
Mailing Address - Fax:702-998-2991
Practice Address - Street 1:6390 W CHEYENNE AVE
Practice Address - Street 2:STE C
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-6009
Practice Address - Country:US
Practice Address - Phone:702-673-7796
Practice Address - Fax:866-611-8528
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205149044Medicaid