Provider Demographics
NPI:1861874109
Name:LASHLEY, TINA (LSCSW)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:LASHLEY
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:LASHLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSCSW
Mailing Address - Street 1:710 LISA RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-2520
Mailing Address - Country:US
Mailing Address - Phone:620-605-7332
Mailing Address - Fax:
Practice Address - Street 1:2809 N BROADWAY ST STE E
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-2684
Practice Address - Country:US
Practice Address - Phone:620-605-7332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-23
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS48881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201119530BMedicaid