Provider Demographics
NPI:1386838845
Name:HODGE, TIFFANY LYNNE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:LYNNE
Last Name:HODGE
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 1:238 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381-1956
Mailing Address - Country:US
Mailing Address - Phone:248-982-5067
Mailing Address - Fax:248-684-2998
Practice Address - Street 1:238 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381-1956
Practice Address - Country:US
Practice Address - Phone:248-982-5067
Practice Address - Fax:248-684-2998
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist