Provider Demographics
NPI:1982424701
Name:POORTINGA, TESSA MARIE (LMHCA)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:MARIE
Last Name:POORTINGA
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:
Other - Last Name:GARZZONA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:809 N LADD AVE
Mailing Address - Street 2:
Mailing Address - City:EAST WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98802-4739
Mailing Address - Country:US
Mailing Address - Phone:509-866-6818
Mailing Address - Fax:
Practice Address - Street 1:809 N LADD AVE
Practice Address - Street 2:
Practice Address - City:EAST WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98802-4739
Practice Address - Country:US
Practice Address - Phone:509-866-6818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61127972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health