Provider Demographics
NPI:1013259191
Name:BRUNNER, TIFFANY (BCBA, BSL, LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BRUNNER
Suffix:
Gender:F
Credentials:BCBA, BSL, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-9781
Mailing Address - Country:US
Mailing Address - Phone:717-587-3759
Mailing Address - Fax:
Practice Address - Street 1:309 N GEORGE ST
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-1523
Practice Address - Country:US
Practice Address - Phone:717-587-3759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC0008072101YP2500X
PABH000070103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH000070OtherBUREAU OF PROFESSIONAL AND OCCUPATIONAL AFFAIRS