Provider Demographics
NPI:1871027490
Name:TINER, MIYOKO (N/A)
Entity Type:Individual
Prefix:
First Name:MIYOKO
Middle Name:
Last Name:TINER
Suffix:
Gender:F
Credentials:N/A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 CLAIRISE CT
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-3570
Mailing Address - Country:US
Mailing Address - Phone:504-228-4668
Mailing Address - Fax:
Practice Address - Street 1:302 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:BOGALUSA
Practice Address - State:LA
Practice Address - Zip Code:70427
Practice Address - Country:US
Practice Address - Phone:985-732-2089
Practice Address - Fax:985-732-2078
Is Sole Proprietor?:No
Enumeration Date:2017-04-20
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health