Provider Demographics
NPI:1598973513
Name:PRESNALL, TIESHA U
Entity Type:Individual
Prefix:
First Name:TIESHA
Middle Name:U
Last Name:PRESNALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 TANGLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-2229
Mailing Address - Country:US
Mailing Address - Phone:810-743-0651
Mailing Address - Fax:810-743-2177
Practice Address - Street 1:4047 S CENTER RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48519-1453
Practice Address - Country:US
Practice Address - Phone:810-743-0651
Practice Address - Fax:810-743-2177
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health