Healthcare Provider Details

I. General information

NPI: 1265305668
Provider Name (Legal Business Name): TIFFANY WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CORPORATE DR
IRVING TX
75038-2509
US

IV. Provider business mailing address

2704 BLUE QUAIL DR
ARLINGTON TX
76017-1652
US

V. Phone/Fax

Practice location:
  • Phone: 214-591-0061
  • Fax:
Mailing address:
  • Phone: 214-591-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number21384
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: