Provider Demographics
NPI:1508184318
Name:TURNER, TIFFANY MATTOCKS (BHRS)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MATTOCKS
Last Name:TURNER
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1834
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-1834
Mailing Address - Country:US
Mailing Address - Phone:817-320-9041
Mailing Address - Fax:918-458-5755
Practice Address - Street 1:1910 S MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5437
Practice Address - Country:US
Practice Address - Phone:918-458-5757
Practice Address - Fax:918-458-5755
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator