Individual provider Active NPI

Jillian Tessier, PHD

  • Psychologist
  • Mill Valley, CA
National Provider Identifier
1093494544
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
PSY34187 Issued in CA
Practice address
100 Shoreline Hwy
Building B, Suite 100
Mill Valley, CA 94941
Phone
(415) 877-4408
NPI assigned
Jul 12, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X PSY34187 CA Primary

Addresses

Primary practice location

100 Shoreline Hwy
Building B, Suite 100
Mill Valley, CA 94941

Mailing address

100 Shoreline Hwy
Building B, Suite 100
Mill Valley, CA 94941
Phone (415) 877-4408

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230807002361 CA Practitioner - Clinical Psychologist 9032570064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kandm Neuropsychology, a Psychology CorporationGroup PAC ID 8921373184, 11 clinicians

Practice addresses (Care Compare)

100 Shoreline Hwy
Suite B386
Mill Valley, CA 94941-6609
Phone (415) 877-4408

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
PSY34187CAMDPsychologist
34187CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
K&M Neuropsychology, a Psychology Corporation CurrentSince Sep 23, 2023 Accepting new patients
California Pacific Medical Group, Inc. PastSince Jul 16, 2023 Accepting new patients

Locations

100 Shoreline Hwy
Ste B386
Mill Valley, CA 94941
Phone (415) 877-4408

100 Shoreline Hwy
Ste B100
Mill Valley, CA 94941
Phone (415) 877-4408

100 Shoreline Hwy
Ste 100
Mill Valley, CA 94941
Phone (408) 410-3671

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1689120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1093494544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 SHORELINE HWY",
            "address_2": "BUILDING B, SUITE 100",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "94941",
            "telephone_number": "415-877-4408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 SHORELINE HWY",
            "address_2": "BUILDING B, SUITE 100",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "94941",
            "telephone_number": "415-877-4408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TESSIER",
        "first_name": "JILLIAN",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-12",
        "last_updated": "2023-07-12",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY34187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mill Valley, CA

Sources for this page

Verify at the official NPI Registry.