Provider Demographics
NPI:1992251060
Name:VASQUEZ, TIFFANY L (LMFT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:VASQUEZ
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 1:7025 N CHESTNUT AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-0351
Mailing Address - Country:US
Mailing Address - Phone:559-984-0101
Mailing Address - Fax:
Practice Address - Street 1:3894 E GETTYSBURG AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-0901
Practice Address - Country:US
Practice Address - Phone:559-454-0822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-29
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF #93771106H00000X
CA93771106H00000X
CA124434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist