Healthcare Provider Details

I. General information

NPI: 1306585922
Provider Name (Legal Business Name): TIFFANY MITCHELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 UPTOWN BLVD FL 2
CEDAR HILL TX
75104-3527
US

IV. Provider business mailing address

610 UPTOWN BLVD FL 2
CEDAR HILL TX
75104-3527
US

V. Phone/Fax

Practice location:
  • Phone: 844-824-8775
  • Fax:
Mailing address:
  • Phone: 844-824-8775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105793
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: