Provider Demographics
NPI:1376094839
Name:MYERS, TIFFANY (MS)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S ORCHARD ST
Mailing Address - Street 2:184
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-1260
Mailing Address - Country:US
Mailing Address - Phone:208-922-6714
Mailing Address - Fax:
Practice Address - Street 1:410 S ORCHARD ST
Practice Address - Street 2:184
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-1260
Practice Address - Country:US
Practice Address - Phone:208-922-6714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6375101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor