Provider Demographics
NPI:1336668656
Name:DERIVE FAMILY THERAPY
Entity Type:Organization
Organization Name:DERIVE FAMILY THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:CHYRENE
Authorized Official - Last Name:CUTTING
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:509-991-0108
Mailing Address - Street 1:12128 N DIVISION ST UNIT 447
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1905
Mailing Address - Country:US
Mailing Address - Phone:509-991-0108
Mailing Address - Fax:
Practice Address - Street 1:12128 N DIVISION ST UNIT 447
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1905
Practice Address - Country:US
Practice Address - Phone:509-991-0108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-18
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)