Provider Demographics
NPI:1093203366
Name:SHEELY, TIFFANY (MS, LMHC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SHEELY
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9407 NE VANCOUVER MALL DR, STE 104 #360
Mailing Address - Street 2:
Mailing Address - City:VANOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662
Mailing Address - Country:US
Mailing Address - Phone:406-224-9131
Mailing Address - Fax:
Practice Address - Street 1:260 NW GOLDEN HILLS DR SPC 4
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-9766
Practice Address - Country:US
Practice Address - Phone:406-224-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61105449101YM0800X
IDLPC-6638101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health