Provider Demographics
NPI:1164255717
Name:FOX, TIFFANY M (SUDPT)
Entity type:Individual
Prefix:MISS
First Name:TIFFANY
Middle Name:M
Last Name:FOX
Suffix:
Gender:F
Credentials:SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6911 RAINIER DR APT 4
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-5140
Mailing Address - Country:US
Mailing Address - Phone:425-309-9152
Mailing Address - Fax:
Practice Address - Street 1:6911 RAINIER DR APT 4
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-5140
Practice Address - Country:US
Practice Address - Phone:425-309-9152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-20
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
WA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)