Provider Demographics
NPI:1053697540
Name:BERRY, TYLISHA
Entity type:Individual
Prefix:MS
First Name:TYLISHA
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 13TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94130-1005
Mailing Address - Country:US
Mailing Address - Phone:415-986-2314
Mailing Address - Fax:415-402-0413
Practice Address - Street 1:1254 13TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94130-1005
Practice Address - Country:US
Practice Address - Phone:415-986-2314
Practice Address - Fax:415-402-0413
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)