Provider Demographics
NPI:1104382563
Name:DEPP, TIFFANY (CDCA,QMHS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:DEPP
Suffix:
Gender:F
Credentials:CDCA,QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 DUNHAM ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-1639
Mailing Address - Country:US
Mailing Address - Phone:419-297-1664
Mailing Address - Fax:
Practice Address - Street 1:5577 AIRPORT HWY STE 102
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7364
Practice Address - Country:US
Practice Address - Phone:419-214-1770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-11
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)