Provider Demographics
NPI:1932688009
Name:TISHKEVICH, NATALIJA (RMHCI)
Entity Type:Individual
Prefix:
First Name:NATALIJA
Middle Name:
Last Name:TISHKEVICH
Suffix:
Gender:F
Credentials:RMHCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 EQUESTRIAN CIR APT 604
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7554
Mailing Address - Country:US
Mailing Address - Phone:239-202-3396
Mailing Address - Fax:
Practice Address - Street 1:1361 ROYAL PALM SQUARE BLVD STE 7
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-1001
Practice Address - Country:US
Practice Address - Phone:239-202-3966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLIMH23173101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker