Provider Demographics
NPI:1508586645
Name:PANGARAKIS, TIFFANY (LCSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:PANGARAKIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 ROSEVINE RD
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:TX
Mailing Address - Zip Code:75930-5406
Mailing Address - Country:US
Mailing Address - Phone:936-596-8475
Mailing Address - Fax:
Practice Address - Street 1:555 ROSEVINE RD
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:TX
Practice Address - Zip Code:75930-5406
Practice Address - Country:US
Practice Address - Phone:936-596-8475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX643821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty