Provider Demographics
NPI:1942878558
Name:TIGGES, MALISSA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MALISSA
Middle Name:
Last Name:TIGGES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MRS
Other - First Name:MALISSA
Other - Middle Name:
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14745 SW 99TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1651
Mailing Address - Country:US
Mailing Address - Phone:469-556-0228
Mailing Address - Fax:
Practice Address - Street 1:14745 SW 99TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1651
Practice Address - Country:US
Practice Address - Phone:469-556-0228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY9465103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent