Healthcare Provider Details

I. General information

NPI: 1477487809
Provider Name (Legal Business Name): TIFFANY ANN LAGE BCAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NUEVO RANCHO LN
HASLET TX
76052-2842
US

IV. Provider business mailing address

5601 GOLDEN TRIANGLE BLVD APT 4237
FORT WORTH TX
76244-4437
US

V. Phone/Fax

Practice location:
  • Phone: 682-374-7520
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: