Provider Demographics
NPI:1922207570
Name:BESHIRS, TISHA LYNE (LPC)
Entity type:Individual
Prefix:
First Name:TISHA
Middle Name:LYNE
Last Name:BESHIRS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 E 24TH ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-3245
Mailing Address - Country:US
Mailing Address - Phone:580-387-0509
Mailing Address - Fax:580-218-8963
Practice Address - Street 1:21 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:OK
Practice Address - Zip Code:73439-6562
Practice Address - Country:US
Practice Address - Phone:580-564-7885
Practice Address - Fax:580-564-7902
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200364120AMedicaid