Provider Demographics
NPI:1235557810
Name:WALTON, TIFFANY ASHLEY (CATC 1)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ASHLEY
Last Name:WALTON
Suffix:
Gender:F
Credentials:CATC 1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 E. BALL RD
Mailing Address - Street 2:SUITE 100P
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806
Mailing Address - Country:US
Mailing Address - Phone:714-517-6147
Mailing Address - Fax:
Practice Address - Street 1:2035 E BALL RD
Practice Address - Street 2:SUITE 100P
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-5159
Practice Address - Country:US
Practice Address - Phone:714-517-6147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-01
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112782101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)