Provider Demographics
NPI:1710239355
Name:POIER, TIFFANI RENE' (MA, MFT)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:RENE'
Last Name:POIER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:TIFFANI
Other - Middle Name:RENE'
Other - Last Name:CANINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:1763 ST. RT 60 SUITE 120
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8707
Mailing Address - Country:US
Mailing Address - Phone:419-289-4825
Mailing Address - Fax:419-289-4826
Practice Address - Street 1:1763 ST. RT 60 SUITE 120
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8707
Practice Address - Country:US
Practice Address - Phone:419-289-4825
Practice Address - Fax:419-289-4826
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 67475106H00000X
M.1800018-TEMP106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1073952271Medicaid