Provider Demographics
NPI:1508434267
Name:KENT, TIANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TIANA
Middle Name:
Last Name:KENT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2391
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-8391
Mailing Address - Country:US
Mailing Address - Phone:312-978-7017
Mailing Address - Fax:
Practice Address - Street 1:400 PARK AVE APT 402
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5030
Practice Address - Country:US
Practice Address - Phone:312-978-7017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist