Healthcare Provider Details

I. General information

NPI: 1013386283
Provider Name (Legal Business Name): TIFFANY NOEL KINGSLEY BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY N FEIST

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 14TH AVE E
SEATTLE WA
98112-5275
US

IV. Provider business mailing address

225 14TH AVE E
SEATTLE WA
98112-5275
US

V. Phone/Fax

Practice location:
  • Phone: 206-402-3168
  • Fax: 206-329-1256
Mailing address:
  • Phone: 206-402-3168
  • Fax: 206-329-1256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61274766
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: