Provider Demographics
NPI:1164717195
Name:WORD, TIFFANI A (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:A
Last Name:WORD
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:TIFFANI
Other - Middle Name:L
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, BCBA
Mailing Address - Street 1:411 W SAINT ELMO RD # 203
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-3374
Mailing Address - Country:US
Mailing Address - Phone:817-875-8423
Mailing Address - Fax:
Practice Address - Street 1:2499 S CAPITAL OF TEXAS HWY STE B203
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7758
Practice Address - Country:US
Practice Address - Phone:512-732-2511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-10-6862103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst