Provider Demographics
NPI:1336856103
Name:RAY, TANISHA J (LISAC)
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:J
Last Name:RAY
Suffix:
Gender:F
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W VALENCIA RD. UNIT #22661
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85734-4668
Mailing Address - Country:US
Mailing Address - Phone:520-230-5174
Mailing Address - Fax:
Practice Address - Street 1:218 E PLACITA LAGO DEL MAGO
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629
Practice Address - Country:US
Practice Address - Phone:520-230-5174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ-15321101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)