Provider Demographics
NPI:1912491366
Name:DRAZDOWSKI, TESS KOVACS (PHD, QMHP, CADCC)
Entity type:Individual
Prefix:DR
First Name:TESS
Middle Name:KOVACS
Last Name:DRAZDOWSKI
Suffix:
Gender:F
Credentials:PHD, QMHP, CADCC
Other - Prefix:MS
Other - First Name:TESS
Other - Middle Name:KATHERINE
Other - Last Name:DRAZDOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 SHELTON MCMURPHEY BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4928
Mailing Address - Country:US
Mailing Address - Phone:541-485-2711
Mailing Address - Fax:888-975-0250
Practice Address - Street 1:10 SHELTON MCMURPHEY BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4928
Practice Address - Country:US
Practice Address - Phone:541-485-2711
Practice Address - Fax:888-975-0250
Is Sole Proprietor?:No
Enumeration Date:2018-06-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
ORT-18-295101YA0400X
CA31103103T00000X
OR3243103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500764726Medicaid
OR500747734Medicaid