MEDICARE: MRS. TIFFANY JACKSON DUNEGHY LLPC

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	6401015314	MI

General Provider Information

NPI Number	:	1598119513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY JACKSON DUNEGHY LLPC

Provider Business Mailing Address
First Line	:	38855 HILLS TECH DR STE 200
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-3428
Country	:	US
Telephone Number	:	248-871-1462
Fax Number	:	248-994-4654

Provider Business Practice Location Address
First Line	:	38855 HILLS TECH DR STE 200
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-3428
Country	:	US
Telephone Number	:	248-871-1462
Fax Number	:	248-994-4654

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

Provider Enumeration Date	:	04/15/2016
Last Update Date	:	04/15/2016

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