Provider Demographics
NPI:1639514037
Name:WILLIAMS, TIFFINI LOREAL (BHRS)
Entity Type:Individual
Prefix:MRS
First Name:TIFFINI
Middle Name:LOREAL
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 NW 187TH ST
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-8922
Mailing Address - Country:US
Mailing Address - Phone:405-412-6079
Mailing Address - Fax:
Practice Address - Street 1:1425 NW 187TH ST
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73012-8922
Practice Address - Country:US
Practice Address - Phone:405-412-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health