Provider Demographics
NPI:1487004644
Name:GOMEZ, TIFFANY SHARON
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SHARON
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 TRANQUILLITY LN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-6165
Mailing Address - Country:US
Mailing Address - Phone:469-245-7095
Mailing Address - Fax:817-516-9102
Practice Address - Street 1:108 TRANQUILLITY LN
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-6165
Practice Address - Country:US
Practice Address - Phone:469-245-7095
Practice Address - Fax:817-516-9102
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health