Healthcare Provider Details

I. General information

NPI: 1790223444
Provider Name (Legal Business Name): TEKIRA TASHONDA TIFFANY FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TEKIRA TASHONDA TIFFANY FOX PLPC

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 09/07/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 LAFAYETTE ST STE 140B
GRETNA LA
70053-5762
US

IV. Provider business mailing address

230 E MAIN ST # 1264
GRAMERCY LA
70052-3177
US

V. Phone/Fax

Practice location:
  • Phone: 504-533-9152
  • Fax: 504-533-9154
Mailing address:
  • Phone: 225-623-9887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberPLPC10495
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLPC10495
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPLPC10495
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberPLPC10495
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: