Provider Demographics
NPI:1811366776
Name:MCGRATH, TIFFANY NICOLE ELISHA
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE ELISHA
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:NICOLE ELISHA
Other - Last Name:FLOREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3504 S BATES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5944
Mailing Address - Country:US
Mailing Address - Phone:509-954-6612
Mailing Address - Fax:
Practice Address - Street 1:5709 W SUNSET HWY STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9446
Practice Address - Country:US
Practice Address - Phone:509-328-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst