Provider Demographics
NPI:1881405744
Name:HANLEY, TISHIRO LETTISHA
Entity type:Individual
Prefix:
First Name:TISHIRO
Middle Name:LETTISHA
Last Name:HANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3926 WILLOW HAMMOCK DR
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-2836
Mailing Address - Country:US
Mailing Address - Phone:340-227-6591
Mailing Address - Fax:
Practice Address - Street 1:151 NW 11TH ST STE W201
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4361
Practice Address - Country:US
Practice Address - Phone:340-227-6591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist