MEDICARE: DEBRA TISLER M.S.ED., QMHPC-T,

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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1194540039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA TISLER M.S.ED., QMHPC-T,

Provider Business Mailing Address
First Line	:	5765F BURKE CENTRE PKWY # 112
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-2233
Country	:	US
Telephone Number	:	571-302-6287
Fax Number	:

Provider Business Practice Location Address
First Line	:	11711 LAKEWOOD LN
Second Line	:
City	:	FAIRFAX STATION
State	:	VA
Zip	:	22039-2102
Country	:	US
Telephone Number	:	571-302-6287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2024
Last Update Date	:	11/16/2024

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