Provider Demographics
NPI:1245799808
Name:EARNEST, TIFFANI SUE
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:SUE
Last Name:EARNEST
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 1:302 E CRYSTAL VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92865-2337
Mailing Address - Country:US
Mailing Address - Phone:714-653-8286
Mailing Address - Fax:
Practice Address - Street 1:3230 E IMPERIAL HWY STE 203
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-1706
Practice Address - Country:US
Practice Address - Phone:714-653-8286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst