Provider Demographics
NPI:1801295266
Name:EDISON, TIFHANIE
Entity type:Individual
Prefix:MISS
First Name:TIFHANIE
Middle Name:
Last Name:EDISON
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 1:118 IMPERIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-7113
Mailing Address - Country:US
Mailing Address - Phone:918-245-9488
Mailing Address - Fax:
Practice Address - Street 1:118 IMPERIAL BLVD
Practice Address - Street 2:
Practice Address - City:SANDSPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063
Practice Address - Country:US
Practice Address - Phone:918-245-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker