Healthcare Provider Details

I. General information

NPI: 1881144954
Provider Name (Legal Business Name): TIFFANY RUZIEV LMHCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY GREY

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 10/30/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 MCGREGOR BLVD APARTMENT 1413
FORT MYERS FL
33901
US

IV. Provider business mailing address

100 N HOWARD ST STE W
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 719-522-3655
  • Fax:
Mailing address:
  • Phone: 204-693-8337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC61480608
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: