Healthcare Provider Details

I. General information

NPI: 1710800933
Provider Name (Legal Business Name): TANISHA Q MCCALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7971 RIVIERA BLVD
MIRAMAR FL
33023-6445
US

IV. Provider business mailing address

2114 N FLAMINGO RD # 944
PEMBROKE PINES FL
33028-3501
US

V. Phone/Fax

Practice location:
  • Phone: 561-450-9528
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4471.
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: