1033766795 NPI number — MRS. TIFFANY DOWNS HADDEN LMSW

Table of content: MRS. TIFFANY DOWNS HADDEN LMSW (NPI 1033766795)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033766795 NPI number — MRS. TIFFANY DOWNS HADDEN LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADDEN
Provider First Name:
TIFFANY
Provider Middle Name:
DOWNS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOWNS
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033766795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4701 FAIRWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72116-8066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-771-8261
Provider Business Mailing Address Fax Number:
501-771-8263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 FAIRWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72116-8066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-771-8261
Provider Business Practice Location Address Fax Number:
501-771-8263
Provider Enumeration Date:
08/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  9544-M , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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