Provider Demographics
NPI:1255610085
Name:TESNOW, DOUGLAS A (LPC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:A
Last Name:TESNOW
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 S VAIL AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-1848
Mailing Address - Country:US
Mailing Address - Phone:847-373-1133
Mailing Address - Fax:
Practice Address - Street 1:625 SLAWIN CT
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-2183
Practice Address - Country:US
Practice Address - Phone:847-789-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.006976101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional