Individual
TESSA J COLTRIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
3800 S NATIONAL AVE STE 770, SPRINGFIELD, MO 65807-5283
(417) 269-6891
(417) 269-5595
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
2007035388
MO
101YP2500X
Professional Counselor
2009010491
MO
103T00000X
Psychologist
Primary
2009010491
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255512778
—
MO
05
—
197065719
—
AR
01
—
431560263
TRICARE
MO
01
—
P01173068
RR MCR
MO
Enumeration date
11/27/2007
Last updated
10/17/2019
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