MEDICARE: MS. TIFFANY D BYNUM LPC

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	101YP2500X	Professional Counselor	68034	TX

General Provider Information

NPI Number	:	1952678963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIFFANY D BYNUM LPC

Provider Business Mailing Address
First Line	:	PO BOX 841538
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-0075
Country	:	US
Telephone Number	:	832-428-6130
Fax Number	:

Provider Business Practice Location Address
First Line	:	2814 ALDINE BENDER RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77032-3502
Country	:	US
Telephone Number	:	832-428-6130
Fax Number	:

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

Provider Enumeration Date	:	11/18/2011
Last Update Date	:	05/23/2013

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