=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326630468
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY NEWMAN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2021
-----------------------------------------------------
Last Update Date | 03/18/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1986 BRIARWOOD ST
-----------------------------------------------------
City | PRATTVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36066-7515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-974-9337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1986 BRIARWOOD ST
-----------------------------------------------------
City | PRATTVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36066-7515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-974-9337
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | L559
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------