Healthcare Provider Details

I. General information

NPI: 1467206789
Provider Name (Legal Business Name): TANISHA LAURICHESSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2024
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27245 BLAKELY PL
VALENCIA CA
91354-2416
US

IV. Provider business mailing address

PO BOX 800367
SANTA CLARITA CA
91380-0367
US

V. Phone/Fax

Practice location:
  • Phone: 714-425-6996
  • Fax:
Mailing address:
  • Phone: 714-425-6996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: