Provider Demographics
NPI:1225384779
Name:NIELSON, TIFFANY MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:NIELSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 EVANS LN
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-1912
Mailing Address - Country:US
Mailing Address - Phone:208-237-4782
Mailing Address - Fax:
Practice Address - Street 1:224 EVANS LN
Practice Address - Street 2:SUITE 1
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-1912
Practice Address - Country:US
Practice Address - Phone:208-237-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-01
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5044101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor