Provider Demographics
NPI:1285200808
Name:HUDDLESTON, TIFFANY (LCSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:MEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3033 PHYLLIS LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-6426
Mailing Address - Country:US
Mailing Address - Phone:972-836-8051
Mailing Address - Fax:972-695-4005
Practice Address - Street 1:1001 E HEBRON PKWY STE 118-252
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-1002
Practice Address - Country:US
Practice Address - Phone:469-701-0443
Practice Address - Fax:972-695-4005
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-03
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX412821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty