MEDICARE: TIGRESS AND CO A BOUTIQUE OF THERAPEUTIC

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	104100000X	Social Worker
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1750012605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIGRESS AND CO A BOUTIQUE OF THERAPEUTIC

Provider Business Mailing Address
First Line	:	225 FRANKLIN RD UNIT 3407
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2754
Country	:	US
Telephone Number	:	916-613-7122
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 FRANKLIN RD UNIT 3407
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-2754
Country	:	US
Telephone Number	:	916-613-7122
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	YOLANDA M BURTON
Credential	:
Telephone Number	:	916-613-7122

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	07/21/2022

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