Provider Demographics
NPI:1427460583
Name:JACQUES, TESSA
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:JACQUES
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 1:2755 QUIET PL
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:95634-9328
Mailing Address - Country:US
Mailing Address - Phone:916-759-4469
Mailing Address - Fax:
Practice Address - Street 1:263 NEVADA STATION
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603
Practice Address - Country:US
Practice Address - Phone:916-415-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77706106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist