MEDICARE: TIERRA LILES

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
1	175T00000X	Peer Specialist	PRS.007549	OH

General Provider Information

NPI Number	:	1710822150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIERRA LILES

Provider Business Mailing Address
First Line	:	1873 LOSANTIVILLE AVE APT 1
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45237-3906
Country	:	US
Telephone Number	:	513-283-6042
Fax Number	:

Provider Business Practice Location Address
First Line	:	7875 MONTGOMERY RD SPC 42
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-4331
Country	:	US
Telephone Number	:	513-283-6042
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2026
Last Update Date	:	04/22/2026

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Directions to “ TIERRA LILES ” Practice Location

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