Provider Demographics
NPI:1629262290
Name:BRUCE, TIFFANY LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:LYNN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:LYNN
Other - Last Name:WORTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1525 W FRYE RD
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6178
Mailing Address - Country:US
Mailing Address - Phone:480-812-7000
Mailing Address - Fax:
Practice Address - Street 1:1525 W FRYE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6178
Practice Address - Country:US
Practice Address - Phone:480-812-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ117120Medicaid