Individual
TIFFANY AMBER BRAKEFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7309 BALMER ST BLDG 545, HILL AFB, UT 84056
(801) 777-7909
Mailing address
2244 N 450 W, LAYTON, UT 84041-5316
(617) 650-2625
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810004946
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
810004946
COMMONWEATH OF VIRGINIA
VA
Enumeration date
04/10/2012
Last updated
06/12/2019
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