MEDICARE: TIFFANI CROOK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1518354307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANI CROOK

Provider Business Mailing Address
First Line	:	2121 WAYWARD SUN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-5406
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2121 WAYWARD SUN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78754-5406
Country	:	US
Telephone Number	:	979-324-7867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2015
Last Update Date	:	03/23/2016

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Directions to “ TIFFANI CROOK ” Practice Location

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