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NPI Code Detail

MEDICARE: TISHA LEE ROWE LADH/MH

MEDICARE: TISHA LEE ROWE LADH/MH
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) Counselor1463OK
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1902395494
Entity Type Code : Individual
Provider Name (Legal Business Name) : TISHA LEE ROWE LADH/MH
Provider Business Mailing Address
First Line : 948 W HEFNER RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-6927
Country : US
Telephone Number : 408-286-9533
Fax Number :
Provider Business Practice Location Address
First Line : 948 W HEFNER RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73114-6927
Country : US
Telephone Number : 408-286-9533
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2018
Last Update Date : 05/06/2024

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