Provider Demographics
NPI:1295741742
Name:TESSER, KAREN (LMSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:TESSER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30482 FOX CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1956
Mailing Address - Country:US
Mailing Address - Phone:248-788-5963
Mailing Address - Fax:248-592-0323
Practice Address - Street 1:37875 W 12 MILE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-3043
Practice Address - Country:US
Practice Address - Phone:248-788-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801019651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI570041OtherVALUE OPTIONS
MI098394OtherMHN
MI71571OtherUNITED BEHAVIORAL HEALTH
MI0004562201OtherAETNA
MI8008974690OtherBLUE CROSS BLUE SHIELD MI
MI0004562201OtherAETNA