Provider Demographics
NPI:1386978773
Name:THORSON, TIFFANY MARIE (LICSW)
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:MARIE
Last Name:THORSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BRADLEY BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4497
Mailing Address - Country:US
Mailing Address - Phone:509-943-5323
Mailing Address - Fax:509-943-2209
Practice Address - Street 1:303 BRADLEY BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4497
Practice Address - Country:US
Practice Address - Phone:509-943-5323
Practice Address - Fax:509-943-2209
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW600896981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical