Provider Demographics
NPI:1063080497
Name:MILLSAP, TIFFANY LYNNE (MED,MS,LPC,LSSP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNNE
Last Name:MILLSAP
Suffix:
Gender:F
Credentials:MED,MS,LPC,LSSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 KINGSLEY DR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76179-6338
Mailing Address - Country:US
Mailing Address - Phone:817-253-0810
Mailing Address - Fax:
Practice Address - Street 1:900 KINGSLEY DR
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76179-6338
Practice Address - Country:US
Practice Address - Phone:817-253-0810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77630101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health