Provider Demographics
NPI:1144669276
Name:MILLER, TISHA ELIZABETH (CADCII)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:CADCII
Other - Prefix:
Other - First Name:TISHA
Other - Middle Name:ELIZABETH
Other - Last Name:URSUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:27281 LAS RAMBLAS STE 140
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6387
Mailing Address - Country:US
Mailing Address - Phone:949-540-0170
Mailing Address - Fax:949-540-0173
Practice Address - Street 1:771 W ORANGETHORPE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2806
Practice Address - Country:US
Practice Address - Phone:714-879-0929
Practice Address - Fax:714-578-2960
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-21
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAII3191214101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)