Provider Demographics
NPI:1184902264
Name:FLORES, TIFFANY RAYEL (LCSW)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:RAYEL
Last Name:FLORES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:RAYEL
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 182
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-0182
Mailing Address - Country:US
Mailing Address - Phone:817-988-7300
Mailing Address - Fax:
Practice Address - Street 1:801 ROAD TO SIX FLAGS W STE 145
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2600
Practice Address - Country:US
Practice Address - Phone:817-459-2433
Practice Address - Fax:817-459-2434
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-24
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX286613903Medicaid