Provider Demographics
NPI:1871726588
Name:O'ROURKE, TIFFANIE L (LMHC)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:L
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TIFFANIE
Other - Middle Name:L
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:4407 N DIVISION ST STE 603
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1660
Mailing Address - Country:US
Mailing Address - Phone:509-640-6411
Mailing Address - Fax:509-606-0411
Practice Address - Street 1:4407 N DIVISION ST STE 603
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1660
Practice Address - Country:US
Practice Address - Phone:509-640-6115
Practice Address - Fax:509-606-0411
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00008900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1871726588Medicaid