Provider Demographics
NPI:1821876954
Name:BARTH, TIFFANY LYSSA (MA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYSSA
Last Name:BARTH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:657 SE COOPER ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-1945
Mailing Address - Country:US
Mailing Address - Phone:971-375-1523
Mailing Address - Fax:
Practice Address - Street 1:1275 NW ADAMS ST STE C
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-3549
Practice Address - Country:US
Practice Address - Phone:971-375-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR8578101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional