Provider Demographics
NPI:1487939203
Name:NOLL, TIFFANY LEA (MA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEA
Last Name:NOLL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17401 VILLAGE GREEN DR
Mailing Address - Street 2:
Mailing Address - City:JERSEY VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:77040-1004
Mailing Address - Country:US
Mailing Address - Phone:713-466-1360
Mailing Address - Fax:
Practice Address - Street 1:17401 VILLAGE GREEN DR
Practice Address - Street 2:
Practice Address - City:JERSEY VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:77040-1004
Practice Address - Country:US
Practice Address - Phone:713-466-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68361101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional