Provider Demographics
NPI:1720348097
Name:KRUMM, TIFFANY JEAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:JEAN
Last Name:KRUMM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:JEAN
Other - Last Name:BILLINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1032 S BRIDGE WAY PL
Mailing Address - Street 2:
Mailing Address - City:EAGLE
Mailing Address - State:ID
Mailing Address - Zip Code:83616-6099
Mailing Address - Country:US
Mailing Address - Phone:208-475-0800
Mailing Address - Fax:208-246-0125
Practice Address - Street 1:1032 S BRIDGE WAY PL
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6099
Practice Address - Country:US
Practice Address - Phone:208-475-0800
Practice Address - Fax:208-246-0125
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4758101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool