Provider Demographics
NPI:1568740595
Name:MOHN, TIFFANY H (PSYD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:H
Last Name:MOHN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 TIPPECANOE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-8180
Mailing Address - Country:US
Mailing Address - Phone:330-286-0436
Mailing Address - Fax:330-286-0462
Practice Address - Street 1:6715 TIPPECANOE RD STE 100
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-8180
Practice Address - Country:US
Practice Address - Phone:330-286-0462
Practice Address - Fax:330-758-4886
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6802103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical