Provider Demographics
NPI:1053994079
Name:JACKSON, TIFFANY ANN (LPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:JACKSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANN
Other - Last Name:HENDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4219 ORANGE GROVE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77039-6313
Mailing Address - Country:US
Mailing Address - Phone:832-470-5888
Mailing Address - Fax:
Practice Address - Street 1:2004 TRUMAN ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4745
Practice Address - Country:US
Practice Address - Phone:281-432-3000
Practice Address - Fax:936-760-2898
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86357101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty