Provider Demographics
NPI:1003391012
Name:VANDERZIEL, TIFFANY FAYE (MA, LPCC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:FAYE
Last Name:VANDERZIEL
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 N BROAD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3569
Mailing Address - Country:US
Mailing Address - Phone:507-225-1500
Mailing Address - Fax:507-225-1501
Practice Address - Street 1:201 N BROAD ST STE 200
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-3569
Practice Address - Country:US
Practice Address - Phone:507-335-1500
Practice Address - Fax:507-225-1501
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MNCC02622101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health