Healthcare Provider Details

I. General information

NPI: 1386157303
Provider Name (Legal Business Name): TIARRA GILBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIARRA ST. CLAIR

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E MARKET ST
WARREN OH
44481-1141
US

IV. Provider business mailing address

150 E MARKET ST
WARREN OH
44481-1141
US

V. Phone/Fax

Practice location:
  • Phone: 330-399-6451
  • Fax: 330-394-6029
Mailing address:
  • Phone: 330-394-6342
  • Fax: 330-394-6029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.184880
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: