Individual
MS. TIFFANY SHELL FLIPPEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSAA
Contact information
Practice address
1016 E. ROOSEVELT AVE., GRANTS, NM 87020
(505) 287-5211
(505) 287-6737
Mailing address
1120 INWOOD AVE, GRANTS, NM 87020
(505) 409-3945
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00729
—
NM
Enumeration date
03/24/2020
Last updated
03/24/2020
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