Individual provider · Type 1 NPI

Tanisha Jonique Willis, MHC-MP

Mental Health Counselor · Patchogue, NY

NPI number 1831080290 Active

Practice location

66A Medford Ave
Patchogue, NY 11772-1202

Call (631) 730-5250 Map

Mailing address

1000 Mill Rd # 1405
Lake Ronkonkoma, NY 11779-1400

Specialties and licenses

TaxonomyCodeLicense
Mental Health Counselor Primary 101YM0800XP134431

Mental Health Counselor: Definition to come...

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About NPI 1831080290

Tanisha Jonique Willis, MHC-MP's National Provider Identifier is 1831080290, issued on Jul 14, 2025. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Patchogue, NY. The record was last updated on Jul 14, 2025.