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General NPI Number Information
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NPI Number | 1770028110
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Entity Type | Individual
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Provider Name | TYISHA MERRITT
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Gender | Female
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Dates
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Enumeration Date | 12/20/2016
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Last Update Date | 07/17/2025
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Provider Practice Location Address
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Address Line | 391 TAYLOR BLVD STE 100
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City | PLEASANT HILL
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State | CA
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Zip | 94523-2289
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Country | US
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Telephone | 925-608-6550
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Fax | 925-608-6592
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Provider Business Mailing Address
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Address Line | 1034 OAK GROVE RD
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City | CONCORD
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State | CA
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Zip | 94518-3225
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Country | US
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Telephone | 925-681-4450
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Fax | 925-646-5365
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | MPSS-QXSVAO
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License Number State | CA
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