Provider Demographics
NPI:1346574035
Name:KELLY, TIFFANY MARIE (MS, LMHC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MARIE
Last Name:KELLY
Suffix:
Gender:F
Credentials:MS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 E 2ND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1439
Mailing Address - Country:US
Mailing Address - Phone:509-315-9776
Mailing Address - Fax:509-202-4322
Practice Address - Street 1:407 E 2ND AVE STE 250
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1439
Practice Address - Country:US
Practice Address - Phone:509-315-9776
Practice Address - Fax:509-202-4322
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60034712101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health