Provider Demographics
NPI:1033848320
Name:CHENNEVILLE, TIFFANY (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:CHENNEVILLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1029
Mailing Address - Country:US
Mailing Address - Phone:727-644-5911
Mailing Address - Fax:
Practice Address - Street 1:9800 4TH ST N STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2462
Practice Address - Country:US
Practice Address - Phone:727-644-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6794103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist