Provider Demographics
NPI:1083252084
Name:TIFT, HEIDE REBEKAH
Entity Type:Individual
Prefix:
First Name:HEIDE
Middle Name:REBEKAH
Last Name:TIFT
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 1:701 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-6014
Mailing Address - Country:US
Mailing Address - Phone:509-838-6092
Mailing Address - Fax:
Practice Address - Street 1:15407 E MISSION AVE STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8527
Practice Address - Country:US
Practice Address - Phone:509-927-1543
Practice Address - Fax:509-927-4761
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-20
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
WACO61312225101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator