Provider Demographics
NPI:1699131862
Name:BASSETT, TIFFANY (MS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BASSETT
Suffix:
Gender:
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SIESTA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33896-8647
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:660 WHITE AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2744
Practice Address - Country:US
Practice Address - Phone:507-227-3817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-04
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014366101YM0800X
CT5928101YM0800X
VA0701012230101YM0800X
NJ37PC00952700101YM0800X
PAPC015859101YM0800X
OHC.2406596101YM0800X
FLTPMC2971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health