Provider Demographics
NPI:1356829253
Name:PESCH, TIFFANY IRENE (MA)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:IRENE
Last Name:PESCH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:IRENE
Other - Last Name:PESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:26010 ACERO
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2799
Mailing Address - Country:US
Mailing Address - Phone:949-353-5018
Mailing Address - Fax:949-356-6443
Practice Address - Street 1:26010 ACERO
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2799
Practice Address - Country:US
Practice Address - Phone:949-353-5018
Practice Address - Fax:949-356-6443
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT97511106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist