Provider Demographics
NPI:1598954612
Name:SCOTT, TIFFANY HOPE ANN (MA)
Entity Type:Individual
Prefix:
First Name:TIFFANY HOPE
Middle Name:ANN
Last Name:SCOTT
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 1:2500 N TEXAS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-1639
Mailing Address - Country:US
Mailing Address - Phone:707-812-4411
Mailing Address - Fax:707-423-2020
Practice Address - Street 1:2500 N TEXAS ST
Practice Address - Street 2:SUITE A
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-1639
Practice Address - Country:US
Practice Address - Phone:707-812-4411
Practice Address - Fax:707-423-2020
Is Sole Proprietor?:No
Enumeration Date:2007-10-15
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54526106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist