Provider Demographics
NPI:1053700179
Name:KING, TIFFANY (MFT)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2929 VISTA BLVD UNIT 50773
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89435-7036
Mailing Address - Country:US
Mailing Address - Phone:310-853-2514
Mailing Address - Fax:
Practice Address - Street 1:3059 VINCINATO DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434
Practice Address - Country:US
Practice Address - Phone:310-853-2514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106923106H00000X
CAIMF 88980106H00000X
390200000X
NV4468-R106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4468-ROtherSTATE OF NEVADA BOARD OF EXAMINERS FOR MFT