Provider Demographics
NPI:1053581017
Name:SELLERS, TIFFANY (MSW, QMHP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:MSW, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 S IH 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-8931
Mailing Address - Country:US
Mailing Address - Phone:512-552-4127
Mailing Address - Fax:
Practice Address - Street 1:1524 S IH 35
Practice Address - Street 2:210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8931
Practice Address - Country:US
Practice Address - Phone:512-552-4127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker