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General NPI Number Information
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NPI Number | 1598845943
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Entity Type | Individual
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Provider Name | LAURA R TISHEY PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 09/11/2024
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Provider Practice Location Address
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Address Line | 655 CRAIG RD STE 230
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7170
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Country | US
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Telephone | 636-248-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 932 ALANSON DR
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City | SAINT LOUIS
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State | MO
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Zip | 63132-5004
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Country | US
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Telephone | 636-248-0568
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2006006569
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License Number State | MO
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