| NPI | 1023366986 |
|---|---|
| Former Name | TIFFANY N WILLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: MO 2015032105) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: KS 2429) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2024-11-08 |