Healthcare Provider Details

I. General information

NPI: 1982530507
Provider Name (Legal Business Name): TIFFANY DUNN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5426 VEGAS DR
LAS VEGAS NV
89108-2403
US

IV. Provider business mailing address

2620 REGATTA DR STE 102
LAS VEGAS NV
89128-6892
US

V. Phone/Fax

Practice location:
  • Phone: 702-806-5268
  • Fax:
Mailing address:
  • Phone: 702-808-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCI5790
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: