MEDICARE: TANISHA CELINE LYNGDOH

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1225708266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANISHA CELINE LYNGDOH

Provider Business Mailing Address
First Line	:	2005 W 14TH STREET
Second Line	:	SUITE 121
City	:	TEMPE
State	:	AZ
Zip	:	85281
Country	:	US
Telephone Number	:	480-610-6981
Fax Number	:	480-898-7419

Provider Business Practice Location Address
First Line	:	2005 W 14TH STREET
Second Line	:	SUITE 121
City	:	TEMPE
State	:	AZ
Zip	:	85281
Country	:	US
Telephone Number	:	480-610-6981
Fax Number	:	480-898-7419

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

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	01/14/2026

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