MEDICARE: MRS. TISHA WYNETTE CALHOUN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	25776	TX

General Provider Information

NPI Number	:	1174781272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TISHA WYNETTE CALHOUN LCSW

Provider Business Mailing Address
First Line	:	2309 WHISPERING CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4420
Country	:	US
Telephone Number	:	817-370-9231
Fax Number	:

Provider Business Practice Location Address
First Line	:	2309 WHISPERING CT
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76133-4420
Country	:	US
Telephone Number	:	817-370-9231
Fax Number	:	817-370-9231

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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