Healthcare Provider Details

I. General information

NPI: 1366184558
Provider Name (Legal Business Name): TIFFANY MCCALL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 07/05/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18001 N 79TH AVE
GLENDALE AZ
85308-8388
US

IV. Provider business mailing address

18001 N 79TH AVE
GLENDALE AZ
85308-8388
US

V. Phone/Fax

Practice location:
  • Phone: 480-586-7181
  • Fax:
Mailing address:
  • Phone: 480-269-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: