Provider Demographics
NPI:1083341481
Name:OCAMPO, TIFFANY (PCLC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:OCAMPO
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MICHAEL GROVE AVE APT 26
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-3678
Mailing Address - Country:US
Mailing Address - Phone:406-548-1353
Mailing Address - Fax:
Practice Address - Street 1:3731 EQUESTRIAN LN
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-5659
Practice Address - Country:US
Practice Address - Phone:406-412-0719
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-PCLC-LIC-56632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional