Provider Demographics
NPI:1073195020
Name:TROMBLEY, TIFFANY LEE
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE
Last Name:TROMBLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22525 SE 64TH PL STE 200
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5307
Mailing Address - Country:US
Mailing Address - Phone:206-291-7484
Mailing Address - Fax:
Practice Address - Street 1:22525 SE 64TH PL STE 200
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5307
Practice Address - Country:US
Practice Address - Phone:206-291-7484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health