Provider Demographics
NPI:1699174326
Name:BLAIR-TISCHER, DONYA (MA, PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:DONYA
Middle Name:
Last Name:BLAIR-TISCHER
Suffix:
Gender:F
Credentials:MA, PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1906 FAIR PARKE LN
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5540
Mailing Address - Country:US
Mailing Address - Phone:701-640-9453
Mailing Address - Fax:
Practice Address - Street 1:1906 FAIR PARKE LN
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-5540
Practice Address - Country:US
Practice Address - Phone:701-640-9453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6011103T00000X
TX38239103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist