Provider Demographics
NPI:1285015685
Name:ATENCIO, TIFFANY NICOLE (LSAA/PLMSW)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:ATENCIO
Suffix:
Gender:F
Credentials:LSAA/PLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 SEAGULL STREET NE SUITE B-200
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109
Mailing Address - Country:US
Mailing Address - Phone:877-299-1655
Mailing Address - Fax:
Practice Address - Street 1:6100 SEAGULL ST NE STE B-200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2500
Practice Address - Country:US
Practice Address - Phone:877-299-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0167841101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)