Provider Demographics
NPI:1821662180
Name:CHESTER-CORTES, TIERA J
Entity Type:Individual
Prefix:MRS
First Name:TIERA
Middle Name:J
Last Name:CHESTER-CORTES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TIERA
Other - Middle Name:J
Other - Last Name:CHESTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TIERA CHESTER-CORTES
Mailing Address - Street 1:1760 FREMONT BLVD STE E1
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-3615
Mailing Address - Country:US
Mailing Address - Phone:831-393-9316
Mailing Address - Fax:
Practice Address - Street 1:1760 FREMONT BLVD STE E1
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-3615
Practice Address - Country:US
Practice Address - Phone:831-393-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11778101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)