Healthcare Provider Details

I. General information

NPI: 1417871468
Provider Name (Legal Business Name): TIFFANY CHANELLE ALEXANDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PRESTON RD STE 400
PLANO TX
75093-5189
US

IV. Provider business mailing address

1400 PRESTON RD STE 400
PLANO TX
75093-5189
US

V. Phone/Fax

Practice location:
  • Phone: 972-665-9835
  • Fax: 214-973-5539
Mailing address:
  • Phone: 972-665-9835
  • Fax: 214-973-5539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number97025
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: