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General NPI Number Information
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NPI Number | 1821807082
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Entity Type | Individual
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Provider Name | TANISHA LORIE MCLEAN PMHNP
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Gender | Female
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Dates
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Enumeration Date | 01/02/2025
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Last Update Date | 01/20/2025
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Provider Practice Location Address
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Address Line | 18411 CRENSHAW BLVD STE 320
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City | TORRANCE
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State | CA
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Zip | 90504-5044
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Country | US
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Telephone | 877-679-8344
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Fax |
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Provider Business Mailing Address
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Address Line | 1455 W REDONDO BEACH BLVD UNIT 2491
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City | GARDENA
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State | CA
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Zip | 90247-6527
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Country | US
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Telephone | 424-237-8083
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95032378
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License Number State | CA
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