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General NPI Number Information
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NPI Number | 1376127126
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Entity Type | Organization
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Legal Business Name | TIFFANY M. BOARDS
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Dates
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Enumeration Date | 05/07/2021
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Last Update Date | 07/26/2024
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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 | 734-561-4102
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Fax |
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Authorized Official
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Title or Position | OWNER / CLINICAL PSYCHOLOGIST
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Name | TIFFANY MICHELLE BOARDS
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Credential | PHD
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Telephone | 734-561-4102
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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 |
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License Number State |
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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 |
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License Number State |
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