MEDICARE: MRS. TIFFANY FORD MA, LPC

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	101YM0800X	Mental Health Counselor	84264	TX

General Provider Information

NPI Number	:	1548923634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY FORD MA, LPC

Provider Business Mailing Address
First Line	:	20903 LAS LOMAS BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2945
Country	:	US
Telephone Number	:	831-272-2773
Fax Number	:

Provider Business Practice Location Address
First Line	:	20903 LAS LOMAS BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-2945
Country	:	US
Telephone Number	:	831-272-2773
Fax Number	:

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

Provider Enumeration Date	:	10/15/2021
Last Update Date	:	05/19/2023

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