Provider Demographics
NPI:1265239321
Name:POWELL, TIARA
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:POWELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2443 COLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-2600
Mailing Address - Country:US
Mailing Address - Phone:513-256-6706
Mailing Address - Fax:
Practice Address - Street 1:2443 COLE AVE SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-2600
Practice Address - Country:US
Practice Address - Phone:612-325-6670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QP0904XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, Federal
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)