Provider Demographics
NPI:1770648164
Name:TIGGS, PAUL L II
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:L
Last Name:TIGGS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 E THUNDERBIRD RD
Mailing Address - Street 2:APARTMENT 2092
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5681
Mailing Address - Country:US
Mailing Address - Phone:602-374-8466
Mailing Address - Fax:
Practice Address - Street 1:3033 E THUNDERBIRD RD
Practice Address - Street 2:APARTMENT 2092
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5681
Practice Address - Country:US
Practice Address - Phone:602-374-8466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC11588101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional