Provider Demographics
NPI:1780089235
Name:SCOGGINS, TIANA JEANETTE
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:JEANETTE
Last Name:SCOGGINS
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 1:4535 COUNTRYCROSSING DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77388-3637
Mailing Address - Country:US
Mailing Address - Phone:832-287-4932
Mailing Address - Fax:832-202-2874
Practice Address - Street 1:4535 COUNTRYCROSSING DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-3637
Practice Address - Country:US
Practice Address - Phone:832-287-4932
Practice Address - Fax:832-202-2874
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-27
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780089235Medicaid