Provider Demographics
NPI:1285360800
Name:KOEVAL, TESSA MEIJER
Entity type:Individual
Prefix:MRS
First Name:TESSA
Middle Name:MEIJER
Last Name:KOEVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TESSA
Other - Middle Name:MORIAH
Other - Last Name:MEIJER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 ARCTIC DRIVE
Mailing Address - Street 2:
Mailing Address - City:BANNER ELK
Mailing Address - State:NC
Mailing Address - Zip Code:28604-8293
Mailing Address - Country:US
Mailing Address - Phone:980-505-3899
Mailing Address - Fax:
Practice Address - Street 1:805 STATE FARM RD STE 304
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4914
Practice Address - Country:US
Practice Address - Phone:561-373-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12497A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12497AOtherMARRIAGE AND FAMILY THERAPY LICENSURE BOARD