Provider Demographics
NPI:1962890590
Name:MENZEL, TIFFANY ROSE (BCBA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ROSE
Last Name:MENZEL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ROSE
Other - Last Name:O'NEILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:926 SQUARE DANCE LN
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4160
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:926 SQUARE DANCE LN
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-4160
Practice Address - Country:US
Practice Address - Phone:325-338-6182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-14-16922103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst