Provider Demographics
NPI:1649312133
Name:SCHMIDT, TINISHA NICOLE (BS)
Entity type:Individual
Prefix:MRS
First Name:TINISHA
Middle Name:NICOLE
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 NATCHEZ TRACE DR APT 11
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-4178
Mailing Address - Country:US
Mailing Address - Phone:731-614-4664
Mailing Address - Fax:
Practice Address - Street 1:24 WEATHERFORD SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2202
Practice Address - Country:US
Practice Address - Phone:731-660-6730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health