Provider Demographics
NPI:1538777420
Name:FAULKNER, TIARRA (LCPC, LPC-MHSP, CCTP)
Entity type:Individual
Prefix:MS
First Name:TIARRA
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LCPC, LPC-MHSP, CCTP
Other - Prefix:MS
Other - First Name:TIARRA
Other - Middle Name:
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6416 PINEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38135-1169
Mailing Address - Country:US
Mailing Address - Phone:901-857-1352
Mailing Address - Fax:
Practice Address - Street 1:6584 POPLAR AVE STE 29
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38138-3687
Practice Address - Country:US
Practice Address - Phone:901-205-9136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-16
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6919101YM0800X
IL178015821101YM0800X
IL180015204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health