Healthcare Provider Details

I. General information

NPI: 1639614019
Provider Name (Legal Business Name): TIARA DEAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIARA WYNN LPC

II. Dates (important events)

Enumeration Date: 12/21/2016
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 WHITE WILLOW WAY
MORGANTOWN WV
26505-6119
US

IV. Provider business mailing address

1005 WHITE WILLOW WAY
MORGANTOWN WV
26505-6119
US

V. Phone/Fax

Practice location:
  • Phone: 304-513-3495
  • Fax: 800-734-8498
Mailing address:
  • Phone: 304-513-3495
  • Fax: 800-734-8498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2229
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: