Individual
DR. LAURA R TISHEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
655 CRAIG RD STE 230, SAINT LOUIS, MO 63141-7170
(636) 248-0568
Mailing address
932 ALANSON DR, SAINT LOUIS, MO 63132-5004
(636) 248-0568
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2006006569
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
490684206
—
MO
Enumeration date
10/17/2006
Last updated
09/11/2024
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