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NPI Code Detail

MEDICARE: TIERA CROSS

MEDICARE: TIERA CROSS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLICDC.163000OH
2101YA0400XAddiction (Substance Use Disorder) CounselorE.2202813-SUPVOH

General Provider Information

NPI Number : 1457870941
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIERA CROSS
Provider Business Mailing Address
First Line : 385 E 215TH ST
Second Line :
City : EUCLID
State : OH
Zip : 44123-1958
Country : US
Telephone Number : 216-534-4935
Fax Number :
Provider Business Practice Location Address
First Line : 1730 W 25TH ST
Second Line :
City : CLEVELAND
State : OH
Zip : 44113-3170
Country : US
Telephone Number : 216-696-4300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2017
Last Update Date : 05/11/2026

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Directions to “ TIERA CROSS ” Practice Location

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