Provider Demographics
NPI:1790223444
Name:FOX, TEKIRA TASHONDA TIFFANY
Entity type:Individual
Prefix:
First Name:TEKIRA
Middle Name:TASHONDA TIFFANY
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:TEKIRA
Other - Middle Name:TASHONDA TIFFANY
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PLPC
Mailing Address - Street 1:230 E MAIN ST # 1264
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-3177
Mailing Address - Country:US
Mailing Address - Phone:225-623-9887
Mailing Address - Fax:
Practice Address - Street 1:1500 LAFAYETTE ST STE 140B
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70053-5762
Practice Address - Country:US
Practice Address - Phone:504-533-9152
Practice Address - Fax:504-533-9154
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2025-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLPC10495101YM0800X, 261QM0801X, 101YP2500X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA101YM0800XMedicaid
LA261QM0801XMedicaid
LA101YP2500XMedicaid
LA171M00000XMedicaid