Tisha Graybill

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW120258 Issued in CA

Practice address

118 Belle Mill Rd
Red Bluff, CA 96080-2850

Phone

(530) 840-2015

Fax

(530) 840-2020

NPI assigned

Sep 27, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Victor Community Support Services, Inc.

  • Community/Behavioral Health Agency
  • Red Bluff, CA
  • NPI 1720751837
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1043769482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 BELLE MILL RD",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960802850",
            "telephone_number": "530-840-2015",
            "fax_number": "530-840-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "118 BELLE MILL RD",
            "city": "RED BLUFF",
            "state": "CA",
            "postal_code": "960802850",
            "telephone_number": "530-840-2015",
            "fax_number": "530-840-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAYBILL",
        "first_name": "TISHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-09-27",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "ASW89580",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW120258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William James Goodin, DDS
• Nicole Fay Gossett
• Marshall Paul Gouze, PH.D.
• Elizabeth Carol Gowan, LMFT
• Randy R Gray, CRNA
• Rodney Roy Green, LCSW, LMFT
• Frank Philip Greene, MD
• Greenville Rancheria
• Greenville Rancheria
• Greenville Rancheria

• All providers in Red Bluff, CA
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.