Provider Demographics
NPI:1700026176
Name:REVES, TIFFANY (LPC-S)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:REVES
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:NIERDIECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-S
Mailing Address - Street 1:2524 LILLIAN MILLER PKWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-7206
Mailing Address - Country:US
Mailing Address - Phone:940-383-1207
Mailing Address - Fax:214-292-8512
Practice Address - Street 1:1206 BENT OAKS CT
Practice Address - Street 2:SUITE 200
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8033
Practice Address - Country:US
Practice Address - Phone:940-381-5010
Practice Address - Fax:940-380-4030
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61531101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor