Provider Demographics
NPI:1154144368
Name:ADEIGBE, TIFFANY IDALIA (LP)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:IDALIA
Last Name:ADEIGBE
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-0156
Mailing Address - Country:US
Mailing Address - Phone:956-266-6599
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 156
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-0156
Practice Address - Country:US
Practice Address - Phone:956-266-6599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39094103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist