Healthcare Provider Details

I. General information

NPI: 1174094551
Provider Name (Legal Business Name): TIFFANY MACHELLE ESPARZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY MACHELLE STRICKLAND

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 10/01/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39TH MEDICAL GROUP
APO AE
09824-0006
US

IV. Provider business mailing address

UNIT 7095 BOX 185
APO AE
09824-7095
US

V. Phone/Fax

Practice location:
  • Phone: 322-316-3380
  • Fax:
Mailing address:
  • Phone: 322-316-6452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number57194
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: