MEDICARE: TIFFANY VON PHAM

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	1041C0700X	Clinical Social Worker	66254	TX

General Provider Information

NPI Number	:	1770307225
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY VON PHAM

Provider Business Mailing Address
First Line	:	7100 OLD KATY RD APT 1404
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2290
Country	:	US
Telephone Number	:	832-562-8322
Fax Number	:

Provider Business Practice Location Address
First Line	:	7100 OLD KATY RD APT 1404
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2290
Country	:	US
Telephone Number	:	832-562-8322
Fax Number	:

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

Provider Enumeration Date	:	11/12/2024
Last Update Date	:	11/12/2024

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Directions to “ TIFFANY VON PHAM ” Practice Location

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