Provider Demographics
NPI:1821825290
Name:COOK, TIFFANY L
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:COOK
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 1:8502 EASTON COMMONS DR APT 404
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2313
Mailing Address - Country:US
Mailing Address - Phone:346-314-8851
Mailing Address - Fax:
Practice Address - Street 1:8502 EASTON COMMONS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3046
Practice Address - Country:US
Practice Address - Phone:346-314-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110942104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker