Healthcare Provider Details

I. General information

NPI: 1528306206
Provider Name (Legal Business Name): TIFFANY NACHE-MORRIS MCCULLUM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY MORRIS PSYD

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 CAMINO ALDEA
CHULA VISTA CA
91913-3337
US

IV. Provider business mailing address

1051 CAMINO ALDEA
CHULA VISTA CA
91913-3337
US

V. Phone/Fax

Practice location:
  • Phone: 619-800-4820
  • Fax:
Mailing address:
  • Phone: 760-907-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: