Provider Demographics
NPI:1114306222
Name:ALFRED, TIFFANY (LPC-S, LMFT-S)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ALFRED
Suffix:
Gender:F
Credentials:LPC-S, LMFT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10651 OLD CLEBURNE CROWLEY JCT
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-9702
Mailing Address - Country:US
Mailing Address - Phone:628-200-9686
Mailing Address - Fax:
Practice Address - Street 1:10651 OLD CLEBURNE CROWLEY JCT
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-9702
Practice Address - Country:US
Practice Address - Phone:628-200-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69240101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional