Provider Demographics
NPI:1952678963
Name:BYNUM, TIFFANY D (LPC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:D
Last Name:BYNUM
Suffix:
Gender:F
Credentials:LPC
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 841538
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-0075
Mailing Address - Country:US
Mailing Address - Phone:832-428-6130
Mailing Address - Fax:
Practice Address - Street 1:2814 ALDINE BENDER RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77032-3502
Practice Address - Country:US
Practice Address - Phone:832-428-6130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-18
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional