Provider Demographics
NPI:1063549509
Name:HUNT, TIFFANY D (IMFT)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:D
Last Name:HUNT
Suffix:
Gender:F
Credentials:IMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-0400
Mailing Address - Country:US
Mailing Address - Phone:909-833-2986
Mailing Address - Fax:909-833-2998
Practice Address - Street 1:233 WEST BASELINE ROAD
Practice Address - Street 2:BOX400
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-0400
Practice Address - Country:US
Practice Address - Phone:909-833-2986
Practice Address - Fax:909-833-2998
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF83877101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health