Provider Demographics
NPI:1609311497
Name:BURLESON, TIFFANY (BS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BURLESON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 FOXGLOVE LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75249-1625
Mailing Address - Country:US
Mailing Address - Phone:318-426-7317
Mailing Address - Fax:
Practice Address - Street 1:5859 FOXGLOVE LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75249
Practice Address - Country:US
Practice Address - Phone:318-426-7317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health