Provider Demographics
NPI:1174094551
Name:ESPARZA, TIFFANY MACHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MACHELLE
Last Name:ESPARZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:MACHELLE
Other - Last Name:STRICKLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:UNIT 7095 BOX 185
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09824-7095
Mailing Address - Country:US
Mailing Address - Phone:322-316-6452
Mailing Address - Fax:
Practice Address - Street 1:39TH MEDICAL GROUP
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09824-0006
Practice Address - Country:US
Practice Address - Phone:322-316-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty