Tessa Marie Mandala, M.ED., LCPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180.011379 Issued in IL

Practice address

5215 N Ravenswood Ave Ste 214
Chicago, IL 60640

Phone

(602) 821-7850

NPI assigned

Feb 18, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

Practice roles

Locations

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.

• Mandala Restorative Therapy

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Chicago, IL
  • NPI 1336624634
  NPD Authorized official

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

{
    "created_epoch": "1455753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539043200000",
    "number": "1922467950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 N RAVENSWOOD AVE STE 214",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401670",
            "telephone_number": "602-821-7850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 N RAVENSWOOD AVE STE 214",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60640",
            "telephone_number": "602-821-7850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3759 N Ravenswood Ave Ste 133",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606133997",
            "country_code": "US",
            "telephone_number": "602-821-7850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANDALA",
        "first_name": "TESSA",
        "middle_name": "MARIE",
        "credential": "M.ED., LCPC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-18",
        "last_updated": "2018-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "178.011594",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180.011379",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sahita Indira Manda
• Alexander Lazar Mandadjiev
• Ronnie Ranjan Mandal, D.O,MBA,MS,MT(ASCP)
• Mandala Counseling & Psychological Services, PLLC
• Mandala Restorative Therapy
• Margaret Mandato
• Mandel Dermatology Chicago PLLC
• Andrea Elizabeth Mandel
• Arthur Michael Mandelin II, MD/PHD
• Cheryl Mandell, DNP

• Professional Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.