Provider Demographics
NPI:1932269099
Name:MOORE-CORTEVILLE, TIFFANY SUSAN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:SUSAN
Last Name:MOORE-CORTEVILLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2545
Mailing Address - Country:US
Mailing Address - Phone:734-301-9346
Mailing Address - Fax:
Practice Address - Street 1:3434 M 119 STE A
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-9373
Practice Address - Country:US
Practice Address - Phone:734-301-9346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 19984101YM0800X
MILLMSW 6801090559101YM0800X
MILMSW 6801090559101YM0800X
MI6801090559104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801090559OtherMICHIGAN DEPT OF COMMUNITY HEALTH
CA19984OtherASW REGISTRATION NUMBER