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General NPI Number Information
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NPI Number | 1871842724
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Entity Type | Individual
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Provider Name | TINA MARIE BISIAUX LADC, LADC-S
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Gender | Female
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Dates
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Enumeration Date | 09/06/2012
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Last Update Date | 04/25/2017
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Provider Practice Location Address
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Address Line | 145 W 3RD ST
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City | BATTLE MOUNTAIN
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State | NV
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Zip | 89820-1970
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Country | US
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Telephone | 775-635-9235
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Fax | 775-635-9235
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Provider Business Mailing Address
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Address Line | PO BOX 652
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City | BATTLE MOUNTAIN
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State | NV
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Zip | 89820-0652
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Country | US
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Telephone | 775-635-9235
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Fax | 775-635-9235
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1781G
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1244L
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License Number State | NV
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