Provider Demographics
NPI:1023584075
Name:MOSS, TIFFANY A (MSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:MOSS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:A
Other - Last Name:STEELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:3321 W KENNEWICK AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2968
Mailing Address - Country:US
Mailing Address - Phone:509-735-6446
Mailing Address - Fax:509-783-2089
Practice Address - Street 1:415 JADWIN AVE
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4368
Practice Address - Country:US
Practice Address - Phone:509-967-6281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALW609435831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health