| NPI | 1871807966 |
|---|---|
| Former Name | TESSA LEE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MT BBH-LCSW-LIC-70) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 104100000X Social Worker (Licence: WY PCSW-417) | |
| 1041C0700X Social Worker, Clinical (Licence: WY PCSW-417) | |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2016-09-30 |