Provider Demographics
NPI:1194277038
Name:STROUP, TIANA ANNALICE (CDPT)
Entity type:Individual
Prefix:MS
First Name:TIANA
Middle Name:ANNALICE
Last Name:STROUP
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11818 SE MILL PLAIN BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5089
Mailing Address - Country:US
Mailing Address - Phone:360-750-9635
Mailing Address - Fax:
Practice Address - Street 1:11818 SE MILL PLAIN BLVD STE 307
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-7017
Practice Address - Country:US
Practice Address - Phone:360-750-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO60613645171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACO60613645OtherCDPT