Provider Demographics
NPI:1679652846
Name:MUSHEGAN, TIFFANY D (LMFT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:MUSHEGAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7740 RIVERSIDE DR
Mailing Address - Street 2:#103G
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7673
Mailing Address - Country:US
Mailing Address - Phone:918-645-3512
Mailing Address - Fax:
Practice Address - Street 1:7740 RIVERSIDE DR
Practice Address - Street 2:#103G
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7673
Practice Address - Country:US
Practice Address - Phone:918-645-3512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK779106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist