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General NPI Number Information
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NPI Number | 1043959638
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Entity Type | Individual
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Provider Name | TIFFANY MARIE BRYANT LPC
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Gender | Female
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Dates
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Enumeration Date | 06/01/2022
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 4225 W GLENDALE AVE STE A201
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City | PHOENIX
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State | AZ
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Zip | 85051-8194
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Country | US
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Telephone | 623-258-1904
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Fax |
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Provider Business Mailing Address
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Address Line | 12317 W DENTON AVE
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City | LITCHFIELD PARK
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State | AZ
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Zip | 85340-3434
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Country | US
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Telephone | 623-258-1904
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | C9021
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-21496
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License Number State | AZ
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