Provider Demographics
NPI:1902149701
Name:PRESTON, TANISHA KIMSHAY
Entity Type:Individual
Prefix:
First Name:TANISHA
Middle Name:KIMSHAY
Last Name:PRESTON
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 1:7520 HOLLORANC CT.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-215-1104
Mailing Address - Fax:
Practice Address - Street 1:3636 LAS VEGAS BLVD N STE B
Practice Address - Street 2:3636 NORTH LAS VEGAS SUITE B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-1556
Practice Address - Country:US
Practice Address - Phone:702-776-8397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-29
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health