Provider Demographics
NPI:1619668761
Name:MCCRAY, TIARA
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:MCCRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 DELMONICO CT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1220
Mailing Address - Country:US
Mailing Address - Phone:719-648-2594
Mailing Address - Fax:
Practice Address - Street 1:450 DELMONICO CT
Practice Address - Street 2:
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1220
Practice Address - Country:US
Practice Address - Phone:719-648-2594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker