Healthcare Provider Details

I. General information

NPI: 1043959638
Provider Name (Legal Business Name): TIFFANY MARIE BRYANT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 SW YAMHILL ST STE 201
PORTLAND OR
97205-2538
US

IV. Provider business mailing address

12317 W DENTON AVE
LITCHFIELD PARK AZ
85340-3434
US

V. Phone/Fax

Practice location:
  • Phone: 971-990-5762
  • Fax:
Mailing address:
  • Phone: 513-252-6939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC9021
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-21496
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: