Provider Demographics
NPI:1780465922
Name:OKORUWA, TIARA A (PHD, LMSW)
Entity type:Individual
Prefix:DR
First Name:TIARA
Middle Name:A
Last Name:OKORUWA
Suffix:
Gender:F
Credentials:PHD, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W MITCHELL ST BOX 19129
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76019-0001
Mailing Address - Country:US
Mailing Address - Phone:682-233-5077
Mailing Address - Fax:
Practice Address - Street 1:501 W MITCHELL ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76019-3107
Practice Address - Country:US
Practice Address - Phone:682-233-5077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59701104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker