Provider Demographics
NPI:1154141273
Name:MEISSEN, TIFFANY
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:MEISSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:GOODSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:210 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-3246
Mailing Address - Country:US
Mailing Address - Phone:510-748-4023
Mailing Address - Fax:
Practice Address - Street 1:210 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-3246
Practice Address - Country:US
Practice Address - Phone:510-748-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool