Provider Demographics
NPI:1215713896
Name:BRANNIGAN, TIIFANY RENEE (MFT,MS)
Entity type:Individual
Prefix:
First Name:TIIFANY
Middle Name:RENEE
Last Name:BRANNIGAN
Suffix:
Gender:F
Credentials:MFT,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 HEREFORD RD
Mailing Address - Street 2:
Mailing Address - City:LAKE SHERWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5108
Mailing Address - Country:US
Mailing Address - Phone:818-324-6184
Mailing Address - Fax:
Practice Address - Street 1:2659 TOWNSGATE RD STE 207
Practice Address - Street 2:
Practice Address - City:WESTLAKE VLG
Practice Address - State:CA
Practice Address - Zip Code:91361-2772
Practice Address - Country:US
Practice Address - Phone:818-324-6184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38627106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty