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NPI Code Detail

MEDICARE: TYESHA BOHANNA

MEDICARE: TYESHA BOHANNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorWV

General Provider Information

NPI Number : 1053276238
Entity Type Code : Individual
Provider Name (Legal Business Name) : TYESHA BOHANNA
Provider Business Mailing Address
First Line : 135 4TH AVE
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-1219
Country : US
Telephone Number : 304-525-5691
Fax Number :
Provider Business Practice Location Address
First Line : 135 4TH AVE
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-1219
Country : US
Telephone Number : 304-525-9651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2025
Last Update Date : 12/19/2025

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Directions to “ TYESHA BOHANNA ” Practice Location

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