Provider Demographics
NPI:1528306206
Name:MCCULLUM, TIFFANY NACHE-MORRIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:NACHE-MORRIS
Last Name:MCCULLUM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:1051 CAMINO ALDEA
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-3337
Mailing Address - Country:US
Mailing Address - Phone:760-907-5115
Mailing Address - Fax:
Practice Address - Street 1:1051 CAMINO ALDEA
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-3337
Practice Address - Country:US
Practice Address - Phone:619-800-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29329103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical