Healthcare Provider Details

I. General information

NPI: 1164210019
Provider Name (Legal Business Name): MS. TIANA B TIFFITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9205 W RUSSELL RD STE 240
LAS VEGAS NV
89148-1425
US

IV. Provider business mailing address

9205 W RUSSELL RD STE 240
LAS VEGAS NV
89148-1425
US

V. Phone/Fax

Practice location:
  • Phone: 702-724-7847
  • Fax:
Mailing address:
  • Phone: 702-421-1259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: