Provider Demographics
NPI:1568000842
Name:BELFROM, TIFFANY (MS, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BELFROM
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 S IH 35 STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2603
Mailing Address - Country:US
Mailing Address - Phone:512-343-8606
Mailing Address - Fax:
Practice Address - Street 1:1524 S IH 35 STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2603
Practice Address - Country:US
Practice Address - Phone:512-343-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional