Individual
MRS. TIFFANY ANN DERRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC-I
Contact information
Practice address
4274 CADIZ DR, FORT WORTH, TX 76133-5412
(817) 690-5196
Mailing address
4274 CADIZ DR, FORT WORTH, TX 76133-5412
(817) 690-5196
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
62801
TX
Other
Enumeration date
05/09/2007
Last updated
07/08/2007
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