Provider Demographics
NPI:1891312294
Name:COTTON, TIFANIE (LMSW-P, MSW)
Entity Type:Individual
Prefix:
First Name:TIFANIE
Middle Name:
Last Name:COTTON
Suffix:
Gender:F
Credentials:LMSW-P, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7565 E US HIGHWAY 66
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-9120
Mailing Address - Country:US
Mailing Address - Phone:405-262-6555
Mailing Address - Fax:
Practice Address - Street 1:7565 E US HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036-9120
Practice Address - Country:US
Practice Address - Phone:405-262-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7390-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker