Provider Demographics
NPI:1770924011
Name:WALTON, TIFFANI (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANI
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44285 LOWTREE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4170
Mailing Address - Country:US
Mailing Address - Phone:661-341-3900
Mailing Address - Fax:661-341-3904
Practice Address - Street 1:44285 LOWTREE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534
Practice Address - Country:US
Practice Address - Phone:661-341-3900
Practice Address - Fax:661-341-3904
Is Sole Proprietor?:No
Enumeration Date:2013-07-16
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA999421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL