Provider Demographics
NPI:1346391687
Name:TIFFANY, MARIA ANNA (LMFT)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ANNA
Last Name:TIFFANY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1925 ASPEN DR
Mailing Address - Street 2:SUITE 100-B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-5459
Mailing Address - Country:US
Mailing Address - Phone:505-820-6867
Mailing Address - Fax:505-424-1975
Practice Address - Street 1:1925 ASPEN DR
Practice Address - Street 2:100-B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5459
Practice Address - Country:US
Practice Address - Phone:505-820-6867
Practice Address - Fax:505-424-1975
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0067712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist