Provider Demographics
NPI:1073045241
Name:MULLIN, TIFFANY ANN I (CP60969079)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ANN
Last Name:MULLIN
Suffix:I
Gender:F
Credentials:CP60969079
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W MISSION AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2347
Mailing Address - Country:US
Mailing Address - Phone:509-474-1148
Mailing Address - Fax:833-899-5113
Practice Address - Street 1:222 W MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2344
Practice Address - Country:US
Practice Address - Phone:509-474-1148
Practice Address - Fax:833-899-5113
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60969079101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)