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NPI Code Detail

MEDICARE: MS. TIFFANY DEAN GREEN

MEDICARE: MS. TIFFANY DEAN GREEN
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
1104100000XSocial Worker67634TX

General Provider Information

NPI Number : 1407489594
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TIFFANY DEAN GREEN
Provider Business Mailing Address
First Line : 2379 BRIARWEST BLVD UNIT 131
Second Line :
City : HOUSTON
State : TX
Zip : 77077-5638
Country : US
Telephone Number : 713-829-3501
Fax Number :
Provider Business Practice Location Address
First Line : 633 E FERNHURST DR STE 1102
Second Line :
City : KATY
State : TX
Zip : 77450-1592
Country : US
Telephone Number : 281-940-8515
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2020
Last Update Date : 02/17/2020

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Directions to “ MS. TIFFANY DEAN GREEN ” Practice Location

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