Provider Demographics
NPI:1053561951
Name:MYLETT, TIFFANY C (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:C
Last Name:MYLETT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 E DEBBIE LN STE 105
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2955
Mailing Address - Country:US
Mailing Address - Phone:682-422-9140
Mailing Address - Fax:682-258-0441
Practice Address - Street 1:751 E DEBBIE LN STE 105
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2955
Practice Address - Country:US
Practice Address - Phone:682-422-9140
Practice Address - Fax:682-258-0441
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX524441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical