| Tisha Darland Llc | |
|
7807 E Funston St Wichita KS 67207-3123 | |
| (316) 636-1188 | |
| (316) 636-1199 |
| Full Name | Tisha Darland Llc |
|---|---|
| Speciality | Social Worker |
| Location | 7807 E Funston St, Wichita, Kansas |
| Authorized Official Name and Position | Tisha Darland (TISHA DARLAND LLC) |
| Authorized Official Contact | 3166361188 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tisha Darland Llc 7807 E Funston St Wichita KS 67207-3123 Ph: (316) 636-1188 | Tisha Darland Llc 7807 E Funston St Wichita KS 67207-3123 Ph: (316) 636-1188 |
| NPI Number | 1497365316 |
|---|---|
| Provider Enumeration Date | 08/05/2020 |
| Last Update Date | 08/05/2020 |
| Certification Date | 08/05/2020 |
| Medicare PECOS PAC ID | 4183044134 |
|---|---|
| Medicare Enrollment ID | O20201014000289 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497365316 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tisha Darland |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508943234 PECOS PAC ID: 6204999238 Enrollment ID: I20090116000254 |
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