Healthcare Provider Details

I. General information

NPI: 1790538122
Provider Name (Legal Business Name): TANISHA OWUSU PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2024
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 4TH AVE N STE 100
NASHVILLE TN
37219-2403
US

IV. Provider business mailing address

159 4TH AVE N STE 100
NASHVILLE TN
37219-2403
US

V. Phone/Fax

Practice location:
  • Phone: 615-669-7768
  • Fax:
Mailing address:
  • Phone: 615-669-7768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number4130
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: