Provider Demographics
NPI:1932251667
Name:HEITHOFF, TIFFANY JILL (PLMHP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:JILL
Last Name:HEITHOFF
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 N 70TH ST
Mailing Address - Street 2:#6
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68507-2195
Mailing Address - Country:US
Mailing Address - Phone:402-440-6769
Mailing Address - Fax:
Practice Address - Street 1:7130 S 29TH ST
Practice Address - Street 2:STE A
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5841
Practice Address - Country:US
Practice Address - Phone:402-420-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health