Provider Demographics
NPI:1497315386
Name:SIMON, TIFFANY (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:SIMON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 LAVENDER CANDLE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-5526
Mailing Address - Country:US
Mailing Address - Phone:281-408-3654
Mailing Address - Fax:
Practice Address - Street 1:17240 HUFFMEISTER RD STE 104
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-4694
Practice Address - Country:US
Practice Address - Phone:281-408-3654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74382101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional