Provider Demographics
NPI:1851950018
Name:GEORDAN, TIFFANI CHEVILL
Entity Type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:CHEVILL
Last Name:GEORDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIFFANI
Other - Middle Name:CHEVILL
Other - Last Name:WHISENHUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 W MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2337
Mailing Address - Country:US
Mailing Address - Phone:509-473-4814
Mailing Address - Fax:
Practice Address - Street 1:1321 W BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2053
Practice Address - Country:US
Practice Address - Phone:509-473-4810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61119368101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor