Healthcare Provider Details

I. General information

NPI: 1720451578
Provider Name (Legal Business Name): TIFFANY HUTCHISON MA, LPC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2015
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN AVE STE 216
GRESHAM OR
97030-7242
US

IV. Provider business mailing address

320 N MAIN AVE STE 216
GRESHAM OR
97030-7242
US

V. Phone/Fax

Practice location:
  • Phone: 971-341-2037
  • Fax:
Mailing address:
  • Phone: 971-341-2037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1720451578
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC5610
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: