Provider Demographics
NPI:1912760398
Name:WOODWARD, TIFFANY MONIQUE (MA, MS, LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MONIQUE
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:MA, MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12614 STABLEWOOD COVE CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77044-2250
Mailing Address - Country:US
Mailing Address - Phone:281-730-2916
Mailing Address - Fax:
Practice Address - Street 1:12614 STABLEWOOD COVE CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-2250
Practice Address - Country:US
Practice Address - Phone:281-730-2916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86627101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health