Provider Demographics
NPI:1023460268
Name:POOLE, TIFFANY (MS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:POOLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:BIRGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3760 RAMBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HORN LAKE
Mailing Address - State:MS
Mailing Address - Zip Code:38637-1534
Mailing Address - Country:US
Mailing Address - Phone:662-234-7521
Mailing Address - Fax:662-236-3071
Practice Address - Street 1:3760 RAMBLEWOOD DR
Practice Address - Street 2:
Practice Address - City:HORN LAKE
Practice Address - State:MS
Practice Address - Zip Code:38637-1534
Practice Address - Country:US
Practice Address - Phone:662-234-7521
Practice Address - Fax:662-236-3071
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-12
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health