Provider Demographics
NPI:1033516695
Name:TISCHER THERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:TISCHER THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONYA
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLAIR-TISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LP
Authorized Official - Phone:218-651-0212
Mailing Address - Street 1:115 5TH ST N
Mailing Address - Street 2:
Mailing Address - City:BRECKENRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:56520-1434
Mailing Address - Country:US
Mailing Address - Phone:218-651-0212
Mailing Address - Fax:
Practice Address - Street 1:115 5TH ST N
Practice Address - Street 2:
Practice Address - City:BRECKENRIDGE
Practice Address - State:MN
Practice Address - Zip Code:56520-1434
Practice Address - Country:US
Practice Address - Phone:218-651-0212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN827251S00000X
ND80410114251S00000X
MN6011251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health