Provider Demographics
NPI:1699502641
Name:LECK, TESSA CLAIRE (MS, LBS)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:CLAIRE
Last Name:LECK
Suffix:
Gender:F
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 1/2 LUZERNE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PITTSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18643-1637
Mailing Address - Country:US
Mailing Address - Phone:272-892-0466
Mailing Address - Fax:
Practice Address - Street 1:804 1/2 LUZERNE AVE
Practice Address - Street 2:
Practice Address - City:WEST PITTSTON
Practice Address - State:PA
Practice Address - Zip Code:18643-1637
Practice Address - Country:US
Practice Address - Phone:272-892-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH007301103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty