Healthcare Provider Details

I. General information

NPI: 1023245800
Provider Name (Legal Business Name): TIFFANY NICOLE TOTTRESS MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 S HOUSTON AVE
TULSA OK
74127-9043
US

IV. Provider business mailing address

1055 S HOUSTON AVE
TULSA OK
74127-9043
US

V. Phone/Fax

Practice location:
  • Phone: 918-921-3200
  • Fax: 918-560-1399
Mailing address:
  • Phone: 189-921-3200
  • Fax: 918-560-1399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4778
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: