Provider Demographics
NPI:1619479136
Name:NOWELL, TIFFANY GAYLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:GAYLE
Last Name:NOWELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:NOWELL
Other - Last Name:PELLETIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 55310
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-5310
Mailing Address - Country:US
Mailing Address - Phone:205-731-9701
Mailing Address - Fax:
Practice Address - Street 1:1713 6TH AVE SOUTH
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-3447
Practice Address - Country:US
Practice Address - Phone:205-934-4107
Practice Address - Fax:205-297-9411
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-28
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSY.0004571103TC0700X
AL2085103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical