Individual
TIFFANIE BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1094 S FIRST ST NE, BROOKHAVEN, MS 39601-4762
(601) 823-4422
Mailing address
402 LEGACY PARK, RIDGELAND, MS 39157-4315
(769) 233-7154
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
81-3700204
MS
Other
Enumeration date
02/05/2026
Last updated
02/05/2026
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