Provider Demographics
NPI:1508214651
Name:JAMES-MELLON, TIARA MARIE
Entity Type:Individual
Prefix:
First Name:TIARA
Middle Name:MARIE
Last Name:JAMES-MELLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIARA
Other - Middle Name:MARIE
Other - Last Name:JAMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72118-2832
Mailing Address - Country:US
Mailing Address - Phone:501-442-2505
Mailing Address - Fax:
Practice Address - Street 1:104 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-2832
Practice Address - Country:US
Practice Address - Phone:501-442-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-31
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist