Provider Demographics
NPI:1760904957
Name:LEBLANC, TIFFINY
Entity Type:Individual
Prefix:
First Name:TIFFINY
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8895 OLD STONEY RD
Mailing Address - Street 2:
Mailing Address - City:PONDER
Mailing Address - State:TX
Mailing Address - Zip Code:76259-4424
Mailing Address - Country:US
Mailing Address - Phone:682-521-9146
Mailing Address - Fax:
Practice Address - Street 1:320 WESTWAY PL STE 530
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-1000
Practice Address - Country:US
Practice Address - Phone:817-516-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor