Provider Demographics
NPI:1942080767
Name:OUTERBRIDGE, TIFFANY MAKEBA (MSW)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:MAKEBA
Last Name:OUTERBRIDGE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111.5 RICHARDSON HWY
Mailing Address - Street 2:PO BOX 383
Mailing Address - City:GLENNALLEN
Mailing Address - State:AK
Mailing Address - Zip Code:99588
Mailing Address - Country:US
Mailing Address - Phone:907-822-5241
Mailing Address - Fax:
Practice Address - Street 1:111.5 RICHARDSON HWY
Practice Address - Street 2:
Practice Address - City:GLENNALLEN
Practice Address - State:AK
Practice Address - Zip Code:99588
Practice Address - Country:US
Practice Address - Phone:907-822-5241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health