Healthcare Provider Details

I. General information

NPI: 1598698714
Provider Name (Legal Business Name): TIFFANY RAYE THOMPSON MA, LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 06/06/2026
Certification Date: 06/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 W AVON RD STE 11
ROCHESTER HILLS MI
48307-2760
US

IV. Provider business mailing address

41153 OAK HILL DR
CLINTON TOWNSHIP MI
48038-4612
US

V. Phone/Fax

Practice location:
  • Phone: 248-650-5009
  • Fax:
Mailing address:
  • Phone: 248-639-0982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6362009959
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: