MEDICARE: JERALE TIFFITH

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	103K00000X	Behavior Analyst		NV

General Provider Information

NPI Number	:	1427450923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERALE TIFFITH

Provider Business Mailing Address
First Line	:	3800 DALECREST DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-8806
Country	:	US
Telephone Number	:	702-502-8465
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 DALECREST DR.
Second Line	:	2801
City	:	LAS VEGAS
State	:	NV
Zip	:	89129
Country	:	US
Telephone Number	:	702-502-8465
Fax Number	:

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

Provider Enumeration Date	:	09/16/2014
Last Update Date	:	09/16/2014

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Directions to “ JERALE TIFFITH ” Practice Location

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