Provider Demographics
NPI:1710316864
Name:IRVING, TIFFANY DIANE (LMFT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:DIANE
Last Name:IRVING
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7052 SANTA TERESA BLVD # 197
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95139-1348
Mailing Address - Country:US
Mailing Address - Phone:650-690-2608
Mailing Address - Fax:
Practice Address - Street 1:7052 SANTA TERESA BLVD # 197
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95139-1348
Practice Address - Country:US
Practice Address - Phone:650-690-2608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111106106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist