MEDICARE: TIARA C AUTRY

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	101Y00000X	Counselor
2	104100000X	Social Worker	S.2005377
3	104100000X	Social Worker	S.2005377	OH

General Provider Information

NPI Number	:	1386890796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIARA C AUTRY

Provider Business Mailing Address
First Line	:	632 DEERING DR
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-5741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2295 W MARKET ST STE J
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44313-6944
Country	:	US
Telephone Number	:	330-614-5438
Fax Number	:

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

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	10/25/2024

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Directions to “ TIARA C AUTRY ” Practice Location

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