Provider Demographics
NPI:1881863173
Name:ENGELDINGER, TIFFANY STAR (MFT)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:STAR
Last Name:ENGELDINGER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 STONERIDGE MALL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3200
Mailing Address - Country:US
Mailing Address - Phone:925-998-3829
Mailing Address - Fax:925-361-0288
Practice Address - Street 1:5820 STONERIDGE MALL RD STE 201
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3200
Practice Address - Country:US
Practice Address - Phone:925-998-3829
Practice Address - Fax:925-361-0288
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51636106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist