Provider Demographics
NPI:1780022178
Name:COSAND, TESSA BREE
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:BREE
Last Name:COSAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25847 VAN LEUVEN ST APT 188
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-2558
Mailing Address - Country:US
Mailing Address - Phone:425-736-7120
Mailing Address - Fax:
Practice Address - Street 1:25847 VAN LEUVEN ST APT 188
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2558
Practice Address - Country:US
Practice Address - Phone:425-736-7120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-07
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
CA11182251S00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health