Individual
KATHRYN TIFFANY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4140 E BASELINE RD STE 101, MESA, AZ 85206-4413
(480) 712-5779
Mailing address
1645 W BASELINE RD UNIT 2114, MESA, AZ 85202-5763
(480) 789-9015
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-17398
AZ
Other
Enumeration date
12/03/2019
Last updated
01/21/2020
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