Provider Demographics
NPI:1235907486
Name:VERNON, TIFFANY DESIRE (LMSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DESIRE
Last Name:VERNON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 N MERIDIAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-8357
Mailing Address - Country:US
Mailing Address - Phone:405-310-3262
Mailing Address - Fax:405-873-6364
Practice Address - Street 1:13301 N MERIDIAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-8357
Practice Address - Country:US
Practice Address - Phone:405-310-3262
Practice Address - Fax:405-873-6364
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8365104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical