Provider Demographics
NPI:1942937784
Name:BLEASE, TIFFANY (LPC, ATR-P)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BLEASE
Suffix:
Gender:F
Credentials:LPC, ATR-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N62W23409 SILVER SPRING DR
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-3830
Mailing Address - Country:US
Mailing Address - Phone:920-296-4474
Mailing Address - Fax:
Practice Address - Street 1:220 W CAPITOL DR
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53212-1185
Practice Address - Country:US
Practice Address - Phone:414-727-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5393-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health