Provider Demographics
NPI:1356197305
Name:LEMEROND, TIEHEENA M (SAC-IT)
Entity type:Individual
Prefix:MRS
First Name:TIEHEENA
Middle Name:M
Last Name:LEMEROND
Suffix:
Gender:F
Credentials:SAC-IT
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 189
Mailing Address - Street 2:
Mailing Address - City:LAC DU FLAMBEAU
Mailing Address - State:WI
Mailing Address - Zip Code:54538-0189
Mailing Address - Country:US
Mailing Address - Phone:715-588-1511
Mailing Address - Fax:715-588-3903
Practice Address - Street 1:533 PEACE PIPE RD
Practice Address - Street 2:
Practice Address - City:LAC DU FLAMBEAU
Practice Address - State:WI
Practice Address - Zip Code:54538-9123
Practice Address - Country:US
Practice Address - Phone:715-588-1511
Practice Address - Fax:715-588-3903
Is Sole Proprietor?:No
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20554-130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)