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NPI Code Detail

MEDICARE: TANISHA KIMSHAY PRESTON

MEDICARE: TANISHA KIMSHAY PRESTON
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1902149701
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANISHA KIMSHAY PRESTON
Provider Business Mailing Address
First Line : 7520 HOLLORANC CT.
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128
Country : US
Telephone Number : 702-215-1104
Fax Number :
Provider Business Practice Location Address
First Line : 3636 LAS VEGAS BLVD N STE B
Second Line : 3636 NORTH LAS VEGAS SUITE B
City : LAS VEGAS
State : NV
Zip : 89115-1556
Country : US
Telephone Number : 702-776-8397
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2013
Last Update Date : 04/04/2013

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Directions to “ TANISHA KIMSHAY PRESTON ” Practice Location

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