Provider Demographics
NPI:1447035936
Name:SAMUELS, TIFFINI
Entity type:Individual
Prefix:
First Name:TIFFINI
Middle Name:
Last Name:SAMUELS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34933 EAGLE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70706-2715
Mailing Address - Country:US
Mailing Address - Phone:561-951-4934
Mailing Address - Fax:
Practice Address - Street 1:34933 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70706-2715
Practice Address - Country:US
Practice Address - Phone:561-951-4934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health