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General NPI Number Information
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NPI Number | 1154619161
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Entity Type | Individual
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Provider Name | TIFFANY M BOARDS PSY.D LLP
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Gender | Female
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Dates
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Enumeration Date | 07/12/2011
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 20411 W 12 MILE RD STE 208
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City | SOUTHFIELD
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State | MI
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Zip | 48076-6405
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Country | US
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Telephone | 734-561-4102
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 CHICAGO BLVD
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City | DETROIT
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State | MI
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Zip | 48202-1419
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Country | US
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Telephone | 313-282-9782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6301018852
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301018852
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License Number State | MI
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