Provider Demographics
NPI:1336694769
Name:JACKSON, TIFFANY ALONNA (AMFT, APCC)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:ALONNA
Last Name:JACKSON
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1171
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92878-1171
Mailing Address - Country:US
Mailing Address - Phone:951-722-7960
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1171
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92878-1171
Practice Address - Country:US
Practice Address - Phone:951-722-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13524101Y00000X
CA138174106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor