Healthcare Provider Details

I. General information

NPI: 1437338423
Provider Name (Legal Business Name): TISHA LINZY LCSW/LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2007
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 BIELBY RD
LAWRENCEBURG IN
47025-1003
US

IV. Provider business mailing address

400 TIGER BLVD
LAWRENCEBURG IN
47025-1687
US

V. Phone/Fax

Practice location:
  • Phone: 812-537-7230
  • Fax:
Mailing address:
  • Phone: 812-537-7239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: