Provider Demographics
NPI:1154042539
Name:THOMPSON, TIERRA RENEE (STNA, CASE MANAGER)
Entity type:Individual
Prefix:
First Name:TIERRA
Middle Name:RENEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:STNA, CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 MONTANA AVE STE 425
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-3829
Mailing Address - Country:US
Mailing Address - Phone:513-954-8005
Mailing Address - Fax:
Practice Address - Street 1:2300 MONTANA AVE STE 425
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-3829
Practice Address - Country:US
Practice Address - Phone:513-954-8005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health