Provider Demographics
NPI:1356048045
Name:WILLIAMS, TYAIRA NY-GERRIA
Entity type:Individual
Prefix:
First Name:TYAIRA
Middle Name:NY-GERRIA
Last Name:WILLIAMS
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 1:2718 ORLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45211-8019
Mailing Address - Country:US
Mailing Address - Phone:513-302-6132
Mailing Address - Fax:
Practice Address - Street 1:6396 THORNBERRY CT STE 710
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-7815
Practice Address - Country:US
Practice Address - Phone:859-282-0440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRBT-23-258431106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician