Provider Demographics
NPI:1972477230
Name:CALHOUN, TYESHA TYSHAY
Entity type:Individual
Prefix:
First Name:TYESHA
Middle Name:TYSHAY
Last Name:CALHOUN
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 1:6544 WELLINGTON CHASE CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-6491
Mailing Address - Country:US
Mailing Address - Phone:470-361-2976
Mailing Address - Fax:
Practice Address - Street 1:6544 WELLINGTON CHASE CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-6491
Practice Address - Country:US
Practice Address - Phone:470-361-2976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-30
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA25-447016106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician