Provider Demographics
NPI:1215452925
Name:CHANG, TIFFANY (PHD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W EL CAMINO AVE # 420
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-1945
Mailing Address - Country:US
Mailing Address - Phone:707-640-1498
Mailing Address - Fax:
Practice Address - Street 1:1500 W EL CAMINO AVE # 420
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-1945
Practice Address - Country:US
Practice Address - Phone:707-640-1498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30685103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist