Provider Demographics
NPI:1952840399
Name:BENTLEY, TIFFANY M (LMHC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2033 NUUANU AVE APT 16B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-2530
Mailing Address - Country:US
Mailing Address - Phone:808-723-2805
Mailing Address - Fax:866-283-2696
Practice Address - Street 1:2033 NUUANU AVE APT 16B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-2530
Practice Address - Country:US
Practice Address - Phone:808-723-2805
Practice Address - Fax:866-283-2696
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMHC431101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health