Provider Demographics
NPI:1295448413
Name:WADLEY, TIFFANI (CSW)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:WADLEY
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19427 DUNRAVEN ST
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7532
Mailing Address - Country:US
Mailing Address - Phone:435-760-6804
Mailing Address - Fax:
Practice Address - Street 1:10233 S PARKER RD STE 300
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9365
Practice Address - Country:US
Practice Address - Phone:435-760-6804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSWC.0000000432101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NAOtherNA