Provider Demographics
NPI:1699976316
Name:EVANS, TIFFANY ANN (LCPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:ANN
Other - Last Name:DENNIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LCPC
Mailing Address - Street 1:1565 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7375
Mailing Address - Country:US
Mailing Address - Phone:406-202-4495
Mailing Address - Fax:
Practice Address - Street 1:40 LAST CHANCE GULCH
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-202-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1497101YP2500X
CAIMF# 52227106H00000X
MTBBH-LCPC-LIC-1497101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000745950OtherBLUE CROSS-SHIELD OF MONTANA