Provider Demographics
NPI:1073198958
Name:CONNELL, TIFFANY (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:881 BETTINA CT APT 683
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-7805
Mailing Address - Country:US
Mailing Address - Phone:832-884-4255
Mailing Address - Fax:
Practice Address - Street 1:881 BETTINA CT APT 683
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-7805
Practice Address - Country:US
Practice Address - Phone:832-884-4255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78579101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty