Basic Information
| Provider Information | |||||||||
| NPI: | 1982196580 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLS BUTCHER | ||||||||
| FirstName: | TISHENA | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LISW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 SHAWNEE LN | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456014145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794888 | ||||||||
| FaxNumber: | 7407794898 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 SHAWNEE LN | ||||||||
| Address2: | |||||||||
| City: | CHILLICOTHE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456014145 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7407794888 | ||||||||
| FaxNumber: | 7407794898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2018 | ||||||||
| LastUpdateDate: | 06/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | I.700488-SUPV | OH | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YM0800X | I.1700488-SUPV | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.