Provider Demographics
NPI:1134513682
Name:WHITE, TIFFANY CRYSTAL
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:CRYSTAL
Last Name:WHITE
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:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-0004
Mailing Address - Country:US
Mailing Address - Phone:559-537-5729
Mailing Address - Fax:
Practice Address - Street 1:1396 W HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-7126
Practice Address - Country:US
Practice Address - Phone:559-256-4474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85258106H00000X
CAMFC109371106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist