Healthcare Provider Details

I. General information

NPI: 1346307014
Provider Name (Legal Business Name): TIFFANY LIND JUMP MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY ANN LIND MFT

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6060 N PARAMOUNT BLVD
LONG BEACH CA
90805-3711
US

IV. Provider business mailing address

6060 N PARAMOUNT BLVD
LONG BEACH CA
90805-3711
US

V. Phone/Fax

Practice location:
  • Phone: 562-630-8672
  • Fax: 562-529-2463
Mailing address:
  • Phone: 562-630-8672
  • Fax: 562-529-2463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 43966
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: