Provider Demographics
NPI:1669299673
Name:MCLENNAN, TIFFANY M
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:MCLENNAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 SKYTOP DR
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-1210
Mailing Address - Country:US
Mailing Address - Phone:817-907-9219
Mailing Address - Fax:
Practice Address - Street 1:1208 W MAGNOLIA AVE STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8801
Practice Address - Country:US
Practice Address - Phone:817-870-1087
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-21
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist