Provider Demographics
NPI:1497007165
Name:HARRIS, TIFFANY DESHAWN (LLPC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:DESHAWN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 LESLIE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48238-3589
Mailing Address - Country:US
Mailing Address - Phone:313-926-1470
Mailing Address - Fax:
Practice Address - Street 1:2545 LESLIE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48238-3589
Practice Address - Country:US
Practice Address - Phone:313-926-1470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011948101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health