Provider Demographics
NPI:1891416764
Name:MCCREARY, TISHA
Entity Type:Individual
Prefix:
First Name:TISHA
Middle Name:
Last Name:MCCREARY
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 1:2795 FRONT ST STE A
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1900
Mailing Address - Country:US
Mailing Address - Phone:330-510-4900
Mailing Address - Fax:330-510-5900
Practice Address - Street 1:2795 FRONT ST STE A
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1900
Practice Address - Country:US
Practice Address - Phone:330-510-4900
Practice Address - Fax:330-510-5900
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.2100168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist