Healthcare Provider Details

I. General information

NPI: 1588501522
Provider Name (Legal Business Name): MS. TIFFANEE B HENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 7TH AVE N APT C
PAYETTE ID
83661-2147
US

IV. Provider business mailing address

555 7TH AVE N APT C
PAYETTE ID
83661-2147
US

V. Phone/Fax

Practice location:
  • Phone: 208-767-8071
  • Fax:
Mailing address:
  • Phone: 208-767-8071
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: