Provider Demographics
NPI:1992182653
Name:CARLSEN, TIFANI JILL (PPS)
Entity type:Individual
Prefix:
First Name:TIFANI
Middle Name:JILL
Last Name:CARLSEN
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-1722
Mailing Address - Country:US
Mailing Address - Phone:559-992-8881
Mailing Address - Fax:559-992-1248
Practice Address - Street 1:1520 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-1722
Practice Address - Country:US
Practice Address - Phone:559-992-8888
Practice Address - Fax:559-992-1248
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool