Provider Demographics
NPI:1083102719
Name:TINSLEY, KIANA JADE (LMHC)
Entity type:Individual
Prefix:MS
First Name:KIANA
Middle Name:JADE
Last Name:TINSLEY
Suffix:
Gender:
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69-10B 188TH STREET
Mailing Address - Street 2:APT 1A
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365
Mailing Address - Country:US
Mailing Address - Phone:646-712-6368
Mailing Address - Fax:
Practice Address - Street 1:17915 INNOVATION
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-2851
Practice Address - Country:US
Practice Address - Phone:646-712-6368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-27
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008440-1101YM0800X
CA6849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health