Provider Demographics
NPI:1821807082
Name:MCLEAN, TANISHA LORIE (PMHNP)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:LORIE
Last Name:MCLEAN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 W REDONDO BEACH BLVD UNIT 2491
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-6527
Mailing Address - Country:US
Mailing Address - Phone:424-237-8083
Mailing Address - Fax:
Practice Address - Street 1:18411 CRENSHAW BLVD STE 320
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90504-5044
Practice Address - Country:US
Practice Address - Phone:877-679-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032378363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health