Provider Demographics
NPI:1093904534
Name:ROBERTS, TIFINI AUTUMN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TIFINI
Middle Name:AUTUMN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 W CHESTERFIELD BLVD
Mailing Address - Street 2:STE. F202
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8650
Mailing Address - Country:US
Mailing Address - Phone:417-886-8540
Mailing Address - Fax:417-886-8560
Practice Address - Street 1:2160 W CHESTERFIELD BLVD
Practice Address - Street 2:STE. F202
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8650
Practice Address - Country:US
Practice Address - Phone:417-886-8540
Practice Address - Fax:417-886-8560
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2008-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007015271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical