Provider Demographics
NPI:1558093906
Name:CHAMPAGNE-LANGABEER, TIFFANY (PHD, RDN, LD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CHAMPAGNE-LANGABEER
Suffix:
Gender:F
Credentials:PHD, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3606 WOODHEAD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-1621
Mailing Address - Country:US
Mailing Address - Phone:281-744-0744
Mailing Address - Fax:
Practice Address - Street 1:3606 WOODHEAD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-1621
Practice Address - Country:US
Practice Address - Phone:281-744-0744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT83759133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDT83759OtherTEXAS DEPARTMENT OF LICENSING AND REGULATION