Provider Demographics
NPI:1609042704
Name:TERRY, TIFFANY JANE
Entity type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:JANE
Last Name:TERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:646 N 1050 W
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-4366
Mailing Address - Country:US
Mailing Address - Phone:435-669-7269
Mailing Address - Fax:
Practice Address - Street 1:646 N 1050 W
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-4366
Practice Address - Country:US
Practice Address - Phone:435-669-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker