Provider Demographics
NPI:1225534431
Name:JOHNSON, TANISHA L
Entity Type:Individual
Prefix:MS
First Name:TANISHA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:TANISHA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1901 WESTBANK EXPY STE 550
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-4362
Mailing Address - Country:US
Mailing Address - Phone:504-832-5123
Mailing Address - Fax:
Practice Address - Street 1:1901 WESTBANK EXPY STE 550
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4362
Practice Address - Country:US
Practice Address - Phone:504-832-5123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator