| Tessa's Therapies Inc | |
|
177 De Rodriguez Ln. San Miguel NM 88058 | |
| (575) 644-9861 | |
| Not Available |
| Full Name | Tessa's Therapies Inc |
|---|---|
| Speciality | Counselor |
| Location | 177 De Rodriguez Ln., San Miguel, New Mexico |
| Authorized Official Name and Position | Theresa A. Ontiveros (CLINICAL DIRECTOR) |
| Authorized Official Contact | 5756449861 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tessa's Therapies Inc Po Box 405 San Miguel NM 88058-0405 Ph: (575) 644-9861 | Tessa's Therapies Inc 177 De Rodriguez Ln. San Miguel NM 88058 Ph: (575) 644-9861 |
| NPI Number | 1013470780 |
|---|---|
| Provider Enumeration Date | 04/10/2019 |
| Last Update Date | 09/27/2019 |
| Medicare PECOS PAC ID | 2567999048 |
|---|---|
| Medicare Enrollment ID | O20241223000088 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013470780 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Amanda G Pryor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255151395 PECOS PAC ID: 1456888932 Enrollment ID: I20241223000123 |
| Provider Name | Tennille Alexa Marrujo-moctezuma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669246443 PECOS PAC ID: 9537696018 Enrollment ID: I20241223000164 |