Provider Demographics
NPI:1750178760
Name:MITCHELL, TIARRA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIARRA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 CONGRESS PARK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4009
Mailing Address - Country:US
Mailing Address - Phone:937-907-1437
Mailing Address - Fax:
Practice Address - Street 1:955 CONGRESS PARK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4009
Practice Address - Country:US
Practice Address - Phone:937-907-1437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist