Provider Demographics
NPI:1528352366
Name:MILLER, TIARA L (LCSW)
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-3475
Mailing Address - Fax:
Practice Address - Street 1:1400 MURRELL TAYLOR DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72076-8118
Practice Address - Country:US
Practice Address - Phone:501-255-2484
Practice Address - Fax:501-642-0388
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2025-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR7878-C1041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR259807719Medicaid
AR116378726Medicaid