Provider Demographics
NPI:1700119609
Name:KERNUTT, TIFFANY KIRSTIN (LCSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:KIRSTIN
Last Name:KERNUTT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:KIRSTIN
Other - Last Name:HAPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2042 GALAXY WAY
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-3324
Mailing Address - Country:US
Mailing Address - Phone:530-262-1560
Mailing Address - Fax:
Practice Address - Street 1:1805 HILLTOP DR STE 102
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0279
Practice Address - Country:US
Practice Address - Phone:530-262-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-09
Last Update Date:2024-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA03-088294101YA0400X
CA772981041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical