Individual provider Active NPI

Tawanna Thierry

  • Child & Adolescent Psychiatry Physician
  • Houston, TX
National Provider Identifier
1881368306
Registry record updated Apr 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
1881368306 Issued in TX
Practice address
3823 E Traditions CT
Houston, TX 77082-3961
Phone
(713) 859-4958
Fax
(337) 513-8891
NPI assigned
Aug 7, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Psychiatry Physician 2084P0800X 1881368306 TX
Child & Adolescent Psychiatry Physician 2084P0804X 1881368306 TX Primary

Addresses

Primary practice location

3823 E Traditions CT
Houston, TX 77082-3961

Mailing address

1019 Mill St
Lake Charles, LA 70601-4439
Phone (713) 859-4958

Other practice location 1

1019 Mill St
Lake Charles, LA 70601-4439
Phone (713) 859-4958

Other identifiers 1

IdentifierTypeStateIssuer
030483402MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250428000030 TX Practitioner - Psychiatry 2860918422 Practice locations: Houston, TX

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1628294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743984000000",
    "number": "1881368306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1019 MILL ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706014439",
            "telephone_number": "713-859-4958",
            "fax_number": "337-513-8891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3823 E TRADITIONS CT",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770823961",
            "telephone_number": "713-859-4958",
            "fax_number": "337-513-8891"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1019 Mill St",
            "address_purpose": "LOCATION",
            "city": "Lake Charles",
            "state": "LA",
            "postal_code": "706014439",
            "country_code": "US",
            "telephone_number": "713-859-4958",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIERRY",
        "first_name": "TAWANNA",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-07",
        "last_updated": "2025-04-07",
        "certification_date": "2025-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "TX",
            "license": "1881368306",
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "TX",
            "license": "1881368306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "030483402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

Verify at the official NPI Registry.