Provider Demographics
NPI:1215111323
Name:QUIJANO, TIFFANY N (LMHC)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:N
Last Name:QUIJANO
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15121 E FALCONS LEA DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-2923
Mailing Address - Country:US
Mailing Address - Phone:954-665-1108
Mailing Address - Fax:
Practice Address - Street 1:15121 E FALCONS LEA DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-2923
Practice Address - Country:US
Practice Address - Phone:954-665-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-26
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health