Provider Demographics
NPI:1750029989
Name:LEWIS, TIFFNY MARIE (BSW, MSW)
Entity Type:Individual
Prefix:
First Name:TIFFNY
Middle Name:MARIE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:BSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 SAN SIMEON DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-3289
Mailing Address - Country:US
Mailing Address - Phone:281-948-0580
Mailing Address - Fax:
Practice Address - Street 1:125 SAN SIMEON DR
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-3289
Practice Address - Country:US
Practice Address - Phone:281-948-0580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty