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General NPI Number Information
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NPI Number | 1205135423
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Entity Type | Individual
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Provider Name | TIFFANY ANN ALLRED LSAC
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Gender | Female
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Dates
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Enumeration Date | 03/28/2011
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Last Update Date | 03/28/2011
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Provider Practice Location Address
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Address Line | 3075 N MAIN ST
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City | SPANISH FORK
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State | UT
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Zip | 84660-9506
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Country | US
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Telephone | 801-851-7688
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 FOOTHILL DR
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City | SANTAQUIN
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State | UT
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Zip | 84655-5507
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Country | US
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Telephone | 801-754-1329
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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 | 6408205-6006
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License Number State | UT
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