Provider Demographics
NPI:1467933051
Name:FALK, TIFFANY MIKA
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MIKA
Last Name:FALK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12304 SANTA MONICA BLVD STE 327
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7207
Mailing Address - Country:US
Mailing Address - Phone:424-261-9213
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 327
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7207
Practice Address - Country:US
Practice Address - Phone:424-261-9213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100143106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty