Healthcare Provider Details

I. General information

NPI: 1750080438
Provider Name (Legal Business Name): TIFFANY ENOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 04/20/2026
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29398 RECOVERY WAY STE 1
JUNCTION CITY OR
97448-8447
US

IV. Provider business mailing address

3587 HEATHROW WAY
MEDFORD OR
97504-4004
US

V. Phone/Fax

Practice location:
  • Phone: 541-995-2210
  • Fax: 541-995-2274
Mailing address:
  • Phone: 541-858-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPROFESSIONALLICENSE
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: