Tiandra L Provo, MHS

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

216 Lobdell Ave
Baton Rouge, LA 70806-4612

Phone

(225) 439-8198

NPI assigned

Oct 1, 2018

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 names 1

• Tiandra Fields Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1497230957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11861 COURSEY BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708164404",
            "telephone_number": "225-612-8656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 LOBDELL AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708064612",
            "telephone_number": "225-439-8198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROVO",
        "first_name": "TIANDRA",
        "middle_name": "L",
        "credential": "MHS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-01",
        "last_updated": "2022-01-26",
        "certification_date": "2022-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TIANDRA",
            "last_name": "FIELDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Providence Medical Clinic
• Provision Personal Care Service
• Provisions Personal Care Services LLC
• Provisions Personal Care Services LLC
• Ladetrick Provo
• Margaret Provost, CSW
• Sylvia Provost
• Stephen Clark Prudhomme, M.D.
• Louis Gordon Pruitt, M.D.
• Dominique Pryer

• Mental Health Counselor in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Mental Health Counselor in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.