Tanisha Renee Wilson, LMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

12401-MH-CC Issued in MA

Practice address

5 High St Ste 101
Medford, MA 02155-3800

Phone

(781) 338-2640

Fax

(781) 338-2217

NPI assigned

Jan 25, 2011

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

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

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623888000000",
    "number": "1497050272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 HIGH ST STE 101",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553800",
            "telephone_number": "781-333-8205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 HIGH ST STE 101",
            "city": "MEDFORD",
            "state": "MA",
            "postal_code": "021553800",
            "telephone_number": "781-338-2640",
            "fax_number": "781-338-2217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "TANISHA",
        "middle_name": "RENEE",
        "credential": "LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-01-25",
        "last_updated": "2021-06-17",
        "certification_date": "2021-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MA",
            "license": "12401-MH-CC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Wilber, D.O.
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• Haley J Willis, OTD, OTR/L
• Winchester Physician Associates (Mystic Valley Pediatrics)
• Winchester Physician Associates (Riverside Healthcare Associates)
• Winchester Physician Associates (Medford Family Care)
• Winchester Wound Care Specialists PLLC
• Marymargaret Winter, R.N.B.A.

• Mental Health Counselor in Medford, MA
• Providers in Medford, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; 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.