Provider Demographics
NPI:1992987481
Name:JOHNSON, TIFFANY CHRISTINE (LPC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:CHRISTINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:CHRISTINE
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:600 3RD ST N STE 206
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-6299
Mailing Address - Country:US
Mailing Address - Phone:608-519-5546
Mailing Address - Fax:
Practice Address - Street 1:600 3RD ST N STE 206
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-6299
Practice Address - Country:US
Practice Address - Phone:608-519-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3576101YP2500X
WI7526-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional