Provider Demographics
NPI:1760636906
Name:KHIEV, TIFFANY (MSW)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:
Last Name:KHIEV
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:SOPHMALLY
Other - Middle Name:
Other - Last Name:SAMOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3133 N MILLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93703-1425
Mailing Address - Country:US
Mailing Address - Phone:559-453-3860
Mailing Address - Fax:
Practice Address - Street 1:3133 N MILLBROOK AVE
Practice Address - Street 2:DEPT. OF CHILDREN & FAMILIES SERVICES
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1425
Practice Address - Country:US
Practice Address - Phone:559-453-3860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health