Provider Demographics
NPI:1538843941
Name:GANTZ, TIFFANY B
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:B
Last Name:GANTZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15347 NEWTON DR
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2809
Mailing Address - Country:US
Mailing Address - Phone:847-363-2446
Mailing Address - Fax:
Practice Address - Street 1:25055 W VALLEY PKWY STE 102
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-8573
Practice Address - Country:US
Practice Address - Phone:785-422-5855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03496-T106H00000X
KS03548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist