Provider Demographics
NPI:1932971942
Name:AVERY, TIFFANY (LLPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:AVERY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35830 PALMER RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48186-4237
Mailing Address - Country:US
Mailing Address - Phone:173-462-4886
Mailing Address - Fax:
Practice Address - Street 1:2050 WASHTENAW RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-1706
Practice Address - Country:US
Practice Address - Phone:734-985-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health