Healthcare Provider Details

I. General information

NPI: 1417870122
Provider Name (Legal Business Name): TIFFANY MARIE CUSHMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30792 SR 54
WESLEY CHAPEL FL
33543-6009
US

IV. Provider business mailing address

1117 LODGE CIR
SPRING HILL FL
34606-5038
US

V. Phone/Fax

Practice location:
  • Phone: 813-701-5250
  • Fax:
Mailing address:
  • Phone: 727-271-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27818
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: