MEDICARE: TIFFANY ANDERSON LMFT-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	206252	TX

General Provider Information

NPI Number	:	1396607198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY ANDERSON LMFT-A

Provider Business Mailing Address
First Line	:	6000 ADELAIDE AVE APT 7310
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76180-2031
Country	:	US
Telephone Number	:	443-717-1218
Fax Number	:	443-717-1218

Provider Business Practice Location Address
First Line	:	6000 ADELAIDE AVE APT 7310
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76180-2031
Country	:	US
Telephone Number	:	443-717-1218
Fax Number	:	443-717-1218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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