Provider Demographics
NPI:1912261751
Name:TESE, BEVERLY JANEY
Entity Type:Individual
Prefix:
First Name:BEVERLY
Middle Name:JANEY
Last Name:TESE
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 1:1215 SULLIVAN LN
Mailing Address - Street 2:68B
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-3556
Mailing Address - Country:US
Mailing Address - Phone:775-338-7661
Mailing Address - Fax:
Practice Address - Street 1:5153 ASPEN VIEW DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-2604
Practice Address - Country:US
Practice Address - Phone:775-338-7661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor