MEDICARE: TIFFANI AMBER SEBASTIAN MFT-IT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	1029228	WI

General Provider Information

NPI Number	:	1861335119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANI AMBER SEBASTIAN MFT-IT

Provider Business Mailing Address
First Line	:	1934 MONROE ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-2027
Country	:	US
Telephone Number	:	815-520-6023
Fax Number	:

Provider Business Practice Location Address
First Line	:	1934 MONROE ST
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711-2027
Country	:	US
Telephone Number	:	815-520-6023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2026
Last Update Date	:	04/13/2026

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