Provider Demographics
NPI:1831465087
Name:TIARA A SLAUGHTER, PHD, PC
Entity Type:Organization
Organization Name:TIARA A SLAUGHTER, PHD, PC
Other - Org Name:TIARA A. ROBERTS, PHD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIARA
Authorized Official - Middle Name:ARLINA
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-456-6997
Mailing Address - Street 1:275 MILLWAY
Mailing Address - Street 2:PO BOX 282
Mailing Address - City:BARNSTABLE
Mailing Address - State:MA
Mailing Address - Zip Code:02630-1102
Mailing Address - Country:US
Mailing Address - Phone:508-362-1955
Mailing Address - Fax:508-296-9516
Practice Address - Street 1:275 MILLWAY
Practice Address - Street 2:
Practice Address - City:BARNSTABLE
Practice Address - State:MA
Practice Address - Zip Code:02630-1102
Practice Address - Country:US
Practice Address - Phone:508-362-1955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-31
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22537103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX032590401Medicaid
TX00D05ROtherMEDICARE 00D05R