Provider Demographics
NPI:1639557176
Name:BRYANT, TIFFANY Y J (PHD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:Y J
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 MOORING CT APT 208
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-2468
Mailing Address - Country:US
Mailing Address - Phone:561-325-9135
Mailing Address - Fax:
Practice Address - Street 1:2790 MOORING CT APT 208
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-2468
Practice Address - Country:US
Practice Address - Phone:561-325-9135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-17
Last Update Date:2015-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 13270101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health