Provider Demographics
NPI:1124368451
Name:TIFFANY MOHN PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:TIFFANY MOHN PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:330-533-1870
Mailing Address - Street 1:6715 TIPPECANOE RD BLDG D
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8180
Mailing Address - Country:US
Mailing Address - Phone:330-533-1870
Mailing Address - Fax:330-533-3484
Practice Address - Street 1:6715 TIPPECANOE RD BLDG D
Practice Address - Street 2:SUITE 100
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8180
Practice Address - Country:US
Practice Address - Phone:330-533-1870
Practice Address - Fax:330-533-3484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6802103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty