Healthcare Provider Details

I. General information

NPI: 1386454395
Provider Name (Legal Business Name): TIFFANY LILLIE MA, LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2025
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 W MERCER ST APT 303
SEATTLE WA
98119-5910
US

IV. Provider business mailing address

522 W RIVERSIDE AVE STE N
SPOKANE WA
99201-0581
US

V. Phone/Fax

Practice location:
  • Phone: 206-420-9778
  • Fax:
Mailing address:
  • Phone: 206-420-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG70084743
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: