Provider Demographics
NPI:1396267845
Name:TESORO, MARY (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:TESORO
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:TESORO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2859 SANTA BARBARA AVE
Mailing Address - Street 2:
Mailing Address - City:CAYUCOS
Mailing Address - State:CA
Mailing Address - Zip Code:93430-1549
Mailing Address - Country:US
Mailing Address - Phone:805-226-6150
Mailing Address - Fax:805-226-6150
Practice Address - Street 1:3522 EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-2531
Practice Address - Country:US
Practice Address - Phone:805-226-6150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99691106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty