Doctor Name: | TYESHA UCHENDU |
NPI Number: | 1467873448 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MHPP |
License Number: | |
Business Practice Address: | 121 Commercial Dr # B Stuttgart, AR - 721607033 |
Business Phone Number: | 8706731633 |
Business Fax Number: | 8706731253 |
Mailing Address: | 2500 Rike Dr, PINE BLUFF |
State: | AR |
Postal Code: | 716033937 |
Phone Number: | 8705341834 |
Fax Number: | 8705345798 |
NPI Enumeration Date: | 12/18/2013 |
NPI Last Update Date: | 06/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |