MEDICARE: TIPH LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	106E00000X	Assistant Behavior Analyst
2	106S00000X	Behavior Technician
3	251S00000X	Community/Behavioral Health Agency
4	253Z00000X	In Home Supportive Care Agency
5	261Q00000X	Clinic/Center
6	261QM1300X	Multi-Specialty Clinic/Center
7	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972114536
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIPH LLC

Provider Business Mailing Address
First Line	:	2637 NW 9TH ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33993-5717
Country	:	US
Telephone Number	:	302-670-6753
Fax Number	:

Provider Business Practice Location Address
First Line	:	1490 NE PINE ISLAND RD STE 7E-F
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33909-2135
Country	:	US
Telephone Number	:	727-513-9076
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANI BRIANA STARKEY
Credential	:	BCBA
Telephone Number	:	727-513-9076

Provider Enumeration Date	:	08/16/2020
Last Update Date	:	08/16/2020

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Directions to “TIPH LLC ” Practice Location

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