Tyiesha Lee White, M.A.

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

7995 Issued in MO

Practice address

104 Henderson St
Troy, IL 62294-1114

Phone

(573) 353-3642

NPI assigned

Jun 6, 2024

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

Other names 1

• TL White Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1717632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717632000000",
    "number": "1326880873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 HENDERSON ST",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941114",
            "telephone_number": "573-353-3642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 HENDERSON ST",
            "city": "TROY",
            "state": "IL",
            "postal_code": "622941114",
            "telephone_number": "573-353-3642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "TYIESHA",
        "middle_name": "LEE",
        "credential": "M.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-06",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "MO",
            "license": "2022046188",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MO",
            "license": "7995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TL",
            "last_name": "WHITE",
            "credential": "M.A.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Addiction (Substance Use Disorder) Counselor in Troy, IL
• Providers in Troy, IL by specialty
• Addiction (Substance Use Disorder) Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 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.