| NPI | 1265818801 |
|---|---|
| Former Name | TESSA LEE IACONO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: TN 1202) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: AZ LMFT-10403) |
| Enumeration Date | 2015-08-05 |
| Last Update Date | 2015-08-05 |