Healthcare Provider Details

I. General information

NPI: 1497277388
Provider Name (Legal Business Name): TIFFANY COMPTOIS LCSW, LMSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2017
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 3 MILE RD NW STE G
GRAND RAPIDS MI
49544-8209
US

IV. Provider business mailing address

3547 ALPINE AVE NW
GRAND RAPIDS MI
49544-1635
US

V. Phone/Fax

Practice location:
  • Phone: 800-693-1916
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801115301
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number110046
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801115301
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: