Healthcare Provider Details

I. General information

NPI: 1699976316
Provider Name (Legal Business Name): TIFFANY ANN EVANS LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIFFANY ANN DENNIS MA, LCPC

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 08/14/2020
Certification Date: 08/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 LAST CHANCE GULCH
HELENA MT
59601
US

IV. Provider business mailing address

1565 VALLEY FORGE RD
HELENA MT
59602-7375
US

V. Phone/Fax

Practice location:
  • Phone: 406-202-4495
  • Fax:
Mailing address:
  • Phone: 406-202-4495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberBBH-LCPC-LIC-1497
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1497
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF# 52227
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: