Provider Demographics
NPI:1376015248
Name:MARTIN, TIFFANY RICHARDSON (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:RICHARDSON
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14231 FM 1464 RD APT 3108
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-7654
Mailing Address - Country:US
Mailing Address - Phone:281-750-9489
Mailing Address - Fax:
Practice Address - Street 1:1601 MAIN ST STE 403
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-3244
Practice Address - Country:US
Practice Address - Phone:281-750-9489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77025101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional