Provider Demographics
NPI:1922825835
Name:ENSLEY, TIARA
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:
Last Name:ENSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 S OTTAWA COVE DR APT 3B
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43611-1482
Mailing Address - Country:US
Mailing Address - Phone:419-320-2666
Mailing Address - Fax:
Practice Address - Street 1:TIARA ENSLEY
Practice Address - Street 2:1931 SOUTH OTTAWA COVE DRIVE 3B
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43611
Practice Address - Country:US
Practice Address - Phone:419-322-0516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X, 103K00000X, 385H00000X
172A00000X, 343900000X, 374U00000X, 347C00000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No172A00000XOther Service ProvidersDriver
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No385H00000XRespite Care FacilityRespite Care
No347C00000XTransportation ServicesPrivate Vehicle