Healthcare Provider Details

I. General information

NPI: 1164350930
Provider Name (Legal Business Name): RISE AND SHINE THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 TULAROSA DR
LAFAYETTE IN
47905-4058
US

IV. Provider business mailing address

4315 COMMERCE DR. SUITE 440 PMB 194
LAFAYETTE IN
47905-0458
US

V. Phone/Fax

Practice location:
  • Phone: 765-233-2001
  • Fax:
Mailing address:
  • Phone: 765-233-2001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TIEFA NICHOLE HERNANDEZ
Title or Position: CEO/OWNER
Credential: MSW, LCSW
Phone: 765-233-2001