1699976316 NPI number — TIFFANY ANN EVANS LCPC

Table of content: TIFFANY ANN EVANS LCPC (NPI 1699976316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699976316 NPI number — TIFFANY ANN EVANS LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
TIFFANY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DENNIS
Provider Other First Name:
TIFFANY
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, LCPC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699976316
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1565 VALLEY FORGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELENA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59602-7375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-202-4495
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 LAST CHANCE GULCH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-202-4495
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  1497 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: IMF# 52227 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: BBH-LCPC-LIC-1497 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000745950 . This is a "BLUE CROSS-SHIELD OF MONTANA" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".