Provider Demographics
NPI:1467237099
Name:SMITH, TIERRA GISCELLE (LPC)
Entity Type:Individual
Prefix:
First Name:TIERRA
Middle Name:GISCELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TIERRA
Other - Middle Name:GISCELLE
Other - Last Name:GARNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8918 W 21ST ST N, STE 200
Mailing Address - Street 2:#197
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-751-8554
Mailing Address - Fax:
Practice Address - Street 1:731 N MCLEAN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4986
Practice Address - Country:US
Practice Address - Phone:316-751-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-30
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04480101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional