Provider Demographics
NPI:1861881245
Name:HEUNG, TESSA
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:HEUNG
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 1:1330 WEST BLVD APT 223
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44102-1748
Mailing Address - Country:US
Mailing Address - Phone:808-228-0499
Mailing Address - Fax:
Practice Address - Street 1:1330 WEST BLVD APT 223
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1748
Practice Address - Country:US
Practice Address - Phone:808-228-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health