Provider Demographics
NPI:1457686800
Name:TRUNNELL, TIFFANY (MA)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:TRUNNELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2187 N VICKEY ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-6121
Mailing Address - Country:US
Mailing Address - Phone:928-527-1899
Mailing Address - Fax:928-714-6480
Practice Address - Street 1:2695 E INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-6109
Practice Address - Country:US
Practice Address - Phone:928-527-1899
Practice Address - Fax:928-527-0028
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-02
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13330101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional