Provider Demographics
NPI:1053861625
Name:HOUCK-LOOMIS, TIFFANY (MDIV, PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:HOUCK-LOOMIS
Suffix:
Gender:F
Credentials:MDIV, PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W 9TH ST APT 10A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8920
Mailing Address - Country:US
Mailing Address - Phone:917-232-7232
Mailing Address - Fax:
Practice Address - Street 1:26 W 9TH ST APT 10A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8920
Practice Address - Country:US
Practice Address - Phone:917-232-7232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-07
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001055102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst