Provider Demographics
NPI:1588918759
Name:GRASTON, TIFFANY TIVON (LCSW INTERN)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:TIVON
Last Name:GRASTON
Suffix:
Gender:F
Credentials:LCSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8916 TORCELLO DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1104
Mailing Address - Country:US
Mailing Address - Phone:702-290-1604
Mailing Address - Fax:
Practice Address - Street 1:2980 S RAINBOW BLVD STE 200-A
Practice Address - Street 2:SUITE #230
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-6531
Practice Address - Country:US
Practice Address - Phone:702-673-7462
Practice Address - Fax:702-442-8900
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6052-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical