Provider Demographics
NPI:1760138135
Name:ELLIS, TANISHA LASHAY
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:LASHAY
Last Name:ELLIS
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 1:13128 THYME WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT HEDWIG
Mailing Address - State:TX
Mailing Address - Zip Code:78152-0257
Mailing Address - Country:US
Mailing Address - Phone:121-083-1466
Mailing Address - Fax:
Practice Address - Street 1:13128 THYME WAY
Practice Address - Street 2:
Practice Address - City:SAINT HEDWIG
Practice Address - State:TX
Practice Address - Zip Code:78152-0257
Practice Address - Country:US
Practice Address - Phone:210-831-4668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker