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: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 N CENTRAL AVE
PHOENIX AZ
85012-1817
US

IV. Provider business mailing address

4502 N CENTRAL AVE
PHOENIX AZ
85012-1817
US

V. Phone/Fax

Practice location:
  • Phone: 480-269-7051
  • Fax:
Mailing address:
  • Phone: 480-269-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: