Provider Demographics
NPI:1457094294
Name:CORNELIS, TIFFANY (CPC-I)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CORNELIS
Suffix:
Gender:F
Credentials:CPC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8414 FARM RD STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-8007
Mailing Address - Country:US
Mailing Address - Phone:702-861-6822
Mailing Address - Fax:
Practice Address - Street 1:8414 FARM RD STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89131-8007
Practice Address - Country:US
Practice Address - Phone:702-861-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI3189101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor