Provider Demographics
NPI:1346549938
Name:POWELL, TIFFANY T
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:T
Last Name:POWELL
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 1:1301 PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-4005
Mailing Address - Country:US
Mailing Address - Phone:415-563-8200
Mailing Address - Fax:415-563-5985
Practice Address - Street 1:1301 PIERCE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-4005
Practice Address - Country:US
Practice Address - Phone:415-563-8200
Practice Address - Fax:415-563-5985
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-22
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor