Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003197781 |
---|---|
Provider Name | Ms. Tiffany Joann Berry |
First Address | Edmond, OK 73013-1908 |
Second Address | Edmond, OK 73013-1908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2011 |
Last Update Date | 02/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
L082058339 | (05) | OK |