Provider Demographics
NPI:1063659381
Name:COURTNAGE, TIFFANY (MSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:COURTNAGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:LORDAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:905 SPRUCE ST, STE 300
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:206-548-3011
Mailing Address - Fax:206-461-6935
Practice Address - Street 1:1629 N 45TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103
Practice Address - Country:US
Practice Address - Phone:206-633-3350
Practice Address - Fax:206-633-3113
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC60041932101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health