Provider Demographics
NPI:1326415597
Name:TESELLE-DELISA, LORI L (MA)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:L
Last Name:TESELLE-DELISA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:L
Other - Last Name:TESELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:2223 S MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7503
Mailing Address - Country:US
Mailing Address - Phone:253-355-2467
Mailing Address - Fax:
Practice Address - Street 1:2223 S MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7503
Practice Address - Country:US
Practice Address - Phone:253-355-2467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF60910751106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist