Provider Demographics
NPI:1154611572
Name:KULA, TIFFANY L (LMFT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:KULA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 E BREEZEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-3017
Mailing Address - Country:US
Mailing Address - Phone:715-697-4329
Mailing Address - Fax:
Practice Address - Street 1:2111 E BREEZEWOOD CT
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-3017
Practice Address - Country:US
Practice Address - Phone:715-697-4329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI152-228106H00000X
WI1040-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI152-228OtherSTATE OF WISCONSIN TRAINING LICENSE
WI1154611572Medicaid