Provider Demographics
NPI:1811496433
Name:DOSS, TIFFANY R (CSS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:R
Last Name:DOSS
Suffix:
Gender:F
Credentials:CSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1535
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:MS
Mailing Address - Zip Code:38879-1535
Mailing Address - Country:US
Mailing Address - Phone:662-322-0781
Mailing Address - Fax:
Practice Address - Street 1:609 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3711
Practice Address - Country:US
Practice Address - Phone:662-728-2488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-09
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health