Provider Demographics
NPI:1770307225
Name:PHAM, TIFFANY VON
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:VON
Last Name:PHAM
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 1:7100 OLD KATY RD APT 1404
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2290
Mailing Address - Country:US
Mailing Address - Phone:832-562-8322
Mailing Address - Fax:
Practice Address - Street 1:7100 OLD KATY RD APT 1404
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2290
Practice Address - Country:US
Practice Address - Phone:832-562-8322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical