Provider Demographics
NPI:1093286437
Name:MACK, TENISHA NICHELLE (ABD, CDCA, CAMS-II)
Entity Type:Individual
Prefix:
First Name:TENISHA
Middle Name:NICHELLE
Last Name:MACK
Suffix:
Gender:F
Credentials:ABD, CDCA, CAMS-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 E 119TH ST
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-857-5463
Mailing Address - Fax:
Practice Address - Street 1:22639 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44117
Practice Address - Country:US
Practice Address - Phone:216-404-1900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator