Provider Demographics
NPI:1720640949
Name:TAPURIAH, TESA LE ANNE (MSAC, CSAC, ICADC)
Entity Type:Individual
Prefix:
First Name:TESA
Middle Name:LE ANNE
Last Name:TAPURIAH
Suffix:
Gender:F
Credentials:MSAC, CSAC, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 RIVER ROCK CT APT 5
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-2008
Mailing Address - Country:US
Mailing Address - Phone:863-800-2018
Mailing Address - Fax:
Practice Address - Street 1:1090 RIVER ROCK CT APT 5
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-2008
Practice Address - Country:US
Practice Address - Phone:863-800-2018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI175T00000X
WI376K00000X
HI3017-21101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist
No376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI3017-21OtherSTATE OF HAWAII ALCOHOL AND DRUG ABUSE DIVISION