Provider Demographics
NPI:1699400861
Name:DAY, TISHA (LCDC)
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:DAY
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1223 PAINTED BUNTING DR
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-1969
Mailing Address - Country:US
Mailing Address - Phone:409-497-6878
Mailing Address - Fax:
Practice Address - Street 1:1223 PAINTED BUNTING DR
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-1969
Practice Address - Country:US
Practice Address - Phone:409-497-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional