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General NPI Number Information
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NPI Number | 1083202436
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Entity Type | Individual
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Provider Name | TIFFANY K O'CONNOR LAC
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Gender | Female
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Dates
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Enumeration Date | 12/31/2020
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Last Update Date | 12/31/2020
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Provider Practice Location Address
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Address Line | 3303 E BASELINE RD STE 109
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City | GILBERT
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State | AZ
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Zip | 85234-2739
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Country | US
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Telephone | 480-900-8765
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Fax |
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Provider Business Mailing Address
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Address Line | 1209 E DEL RIO DR
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City | TEMPE
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State | AZ
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Zip | 85282-3918
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Country | US
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Telephone | 480-544-1036
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LAC-12798
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License Number State | AZ
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