MEDICARE: THEMBA MSISHA

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	101YM0800X	Mental Health Counselor	C.2305061	OH

General Provider Information

NPI Number	:	1407715923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEMBA MSISHA

Provider Business Mailing Address
First Line	:	4042 EMERALD LAKES BLVD
Second Line	:
City	:	POWELL
State	:	OH
Zip	:	43065-7517
Country	:	US
Telephone Number	:	740-860-9943
Fax Number	:

Provider Business Practice Location Address
First Line	:	751 NORTHWEST BLVD STE 200
Second Line	:
City	:	GRANDVIEW
State	:	OH
Zip	:	43212-1977
Country	:	US
Telephone Number	:	740-860-9943
Fax Number	:

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

Provider Enumeration Date	:	01/20/2026
Last Update Date	:	01/20/2026

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Directions to “ THEMBA MSISHA ” Practice Location

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