Provider Demographics
NPI:1881049815
Name:PHILLIPS, TANISHA (LPC)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 POPPS FERRY RD APT B220
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2063
Mailing Address - Country:US
Mailing Address - Phone:225-810-8277
Mailing Address - Fax:
Practice Address - Street 1:240 EISENHOWER DR STE C2
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-3649
Practice Address - Country:US
Practice Address - Phone:601-342-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health