Provider Demographics
NPI:1972049104
Name:KIM, TESS YONG (LPCC)
Entity type:Individual
Prefix:
First Name:TESS
Middle Name:YONG
Last Name:KIM
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 ORTIZ DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1444
Mailing Address - Country:US
Mailing Address - Phone:808-772-3144
Mailing Address - Fax:
Practice Address - Street 1:1102 MOUNTAIN RD NW STE 202
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1855
Practice Address - Country:US
Practice Address - Phone:808-772-3144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-11
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCCMH0217631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health