Provider Demographics
NPI:1245991215
Name:LUSE, TIFFANY H
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:H
Last Name:LUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26302
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35260-0302
Mailing Address - Country:US
Mailing Address - Phone:205-901-9055
Mailing Address - Fax:
Practice Address - Street 1:2008 21ST STREET ENSLEY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-2963
Practice Address - Country:US
Practice Address - Phone:205-224-4387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty