Provider Demographics
NPI:1285112995
Name:TSCHANTZ, TIFFANY R (LAC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:R
Last Name:TSCHANTZ
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:R
Other - Last Name:HIPWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:6401 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85042-4417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6401 S 16TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85042-4417
Practice Address - Country:US
Practice Address - Phone:623-337-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12772101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor