Tierra Makenzie Coalman, R-AAC, CPC

Primary specialty

Peer SpecialistTaxonomy code 175T00000X

License

CG61424610 Issued in WA

Practice address

1400 Commerce Ave
Longview, WA 98632-3756

Phone

(360) 998-2047

Fax

(360) 200-6736

NPI assigned

Mar 27, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Tierra Makenzie Despain Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Core Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Longview, WA
  • NPI 1639693781
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1679875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1205530201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2394",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986328455",
            "telephone_number": "360-425-8679",
            "fax_number": "844-612-6673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 COMMERCE AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986323756",
            "telephone_number": "360-998-2047",
            "fax_number": "360-200-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COALMAN",
        "first_name": "TIERRA",
        "middle_name": "MAKENZIE",
        "credential": "R-AAC, CPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-27",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "CG61424610",
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "WA",
            "license": "CG61424610",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2242156",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIERRA",
            "last_name": "DESPAIN",
            "middle_name": "MAKENZIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kim J. Clark, LMP
• Leshay M Clark
• Delaney G Clayburg
• Susan Elizabeth Cleveland, MA, NCC
• Cna School of Longview Health Education Center Inc
• Hayley Alexandra Coalter
• Vicky Ilene Coauette-Owens, AAC, MHP
• Vincent Guy Cochran
• Christin G Cole, AAS, R-AAC, CPC
• Amanda Nichole Coleman

• Peer Specialist in Longview, WA
• Providers in Longview, WA by specialty
• Peer Specialist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.