Provider Demographics
NPI:1720568678
Name:HARRIS, TIFFANY ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:HARRIS
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 1:7047 GERMANTOWN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1866
Mailing Address - Country:US
Mailing Address - Phone:651-276-9674
Mailing Address - Fax:
Practice Address - Street 1:7047 GERMANTOWN AVE STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1866
Practice Address - Country:US
Practice Address - Phone:267-606-0942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist