Provider Demographics
NPI:1902236839
Name:SHANKS, TIFFANY C (MA)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:C
Last Name:SHANKS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21243 VENTURA BLVD
Mailing Address - Street 2:SUITE 118
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2109
Mailing Address - Country:US
Mailing Address - Phone:818-493-9580
Mailing Address - Fax:818-657-7019
Practice Address - Street 1:21243 VENTURA BLVD
Practice Address - Street 2:118
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2109
Practice Address - Country:US
Practice Address - Phone:818-493-9580
Practice Address - Fax:818-657-7019
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-13
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist