Individual
TIFFANIE DIANE LONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
13932 COYOTE GULCH, POCATELLO, ID 83202-5195
(208) 410-0100
Mailing address
13932 COYOTE GULCH, POCATELLO, ID 83202-5195
(208) 410-0100
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LCPC-8664
—
Other
Enumeration date
07/18/2019
Last updated
07/06/2023
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