Provider Demographics
NPI:1831673631
Name:CORWIN, TIFFANY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CORWIN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 SW JEFFERSON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-7710
Mailing Address - Country:US
Mailing Address - Phone:971-266-6910
Mailing Address - Fax:
Practice Address - Street 1:2130 SW JEFFERSON ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-7710
Practice Address - Country:US
Practice Address - Phone:971-266-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17065101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health