Provider Demographics
NPI:1154619161
Name:BOARDS, TIFFANY M (PSYD LLP)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:M
Last Name:BOARDS
Suffix:
Gender:F
Credentials:PSYD LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 CHICAGO BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1419
Mailing Address - Country:US
Mailing Address - Phone:313-282-9782
Mailing Address - Fax:
Practice Address - Street 1:20411 W 12 MILE RD STE 208
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-6405
Practice Address - Country:US
Practice Address - Phone:734-561-4102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018852103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling