Healthcare Provider Details

I. General information

NPI: 1154736155
Provider Name (Legal Business Name): TIFFANY BYRD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6396 MCLEOD DR SUITE 9
LAS VEGAS NV
89120-4428
US

IV. Provider business mailing address

5250 JUNGLE ORCHARD ST
NORTH LAS VEGAS NV
89031-0572
US

V. Phone/Fax

Practice location:
  • Phone: 702-912-0600
  • Fax: 702-912-0601
Mailing address:
  • Phone: 702-353-6569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: