Provider Demographics
NPI:1891357554
Name:RUNGE, TIFFANY RHIANNON MONIQUE (MA, AMFT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RHIANNON MONIQUE
Last Name:RUNGE
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2042
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-2042
Mailing Address - Country:US
Mailing Address - Phone:530-990-1078
Mailing Address - Fax:
Practice Address - Street 1:572 RIO LINDO AVE STE 104F
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1851
Practice Address - Country:US
Practice Address - Phone:530-518-1406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT112914106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist