Provider Demographics
NPI:1871842724
Name:BISIAUX, TINA MARIE (LADC, LADC-S)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:BISIAUX
Suffix:
Gender:F
Credentials:LADC, LADC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 652
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820-0652
Mailing Address - Country:US
Mailing Address - Phone:775-635-9235
Mailing Address - Fax:775-635-9235
Practice Address - Street 1:145 W 3RD ST
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820-1970
Practice Address - Country:US
Practice Address - Phone:775-635-9235
Practice Address - Fax:775-635-9235
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1781G101Y00000X
NV1244L101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor