Provider Demographics
NPI:1508176769
Name:LOUIS, TIANA MAKAIWA PARK (LCADC, CPC-INTERN)
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:MAKAIWA PARK
Last Name:LOUIS
Suffix:
Gender:F
Credentials:LCADC, CPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3970 S HOWICK ST UNIT B135
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-1491
Mailing Address - Country:US
Mailing Address - Phone:702-271-9458
Mailing Address - Fax:
Practice Address - Street 1:3970 S HOWICK ST UNIT B135
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-1491
Practice Address - Country:US
Practice Address - Phone:702-271-9458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI0047101YP2500X
CO0022392101YP2500X
UT127859346004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional