Individual
DR. RAYMOND R TESAURO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ED.D.
Contact information
Practice address
107 HOLLAND ST, SHELBYVILLE, TN 37160-3927
(931) 680-4370
(931) 680-4370
Mailing address
PO BOX 743, LEBANON, TN 37088-0743
(931) 680-4370
(931) 680-4370
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000001934
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3687153
—
TN
05
—
3687158
—
TN
Enumeration date
07/11/2006
Last updated
07/08/2007
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