Provider Demographics
NPI:1063147593
Name:ANDERSON, TENEISHA
Entity type:Individual
Prefix:
First Name:TENEISHA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 E AVENUE I APT 173
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-2064
Mailing Address - Country:US
Mailing Address - Phone:166-182-5671
Mailing Address - Fax:
Practice Address - Street 1:615 E AVENUE I APT 173
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-2064
Practice Address - Country:US
Practice Address - Phone:661-825-6716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-19
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician