Provider Demographics
NPI:1831814649
Name:GAINES, TIFFANI ROLANNA (MS IN PSYCHOLOGY)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:ROLANNA
Last Name:GAINES
Suffix:
Gender:F
Credentials:MS IN PSYCHOLOGY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16951 ADDISON RD APT 806
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5103
Mailing Address - Country:US
Mailing Address - Phone:318-372-2896
Mailing Address - Fax:
Practice Address - Street 1:1201 N WATSON RD STE 226
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-6222
Practice Address - Country:US
Practice Address - Phone:682-321-7004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program