Provider Demographics
NPI:1467919589
Name:WADE, TIFFANI (LPC, LPCC)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:WADE
Suffix:
Gender:F
Credentials:LPC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8250 E GOLF LINKS RD APT 179
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85730-1266
Mailing Address - Country:US
Mailing Address - Phone:310-351-9291
Mailing Address - Fax:
Practice Address - Street 1:3295 W INA RD STE 125
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2195
Practice Address - Country:US
Practice Address - Phone:520-257-1168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA559101Y00000X
AZ17586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor