Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1013197656 |
---|---|
Provider Name | Ms. Tiffany Secrest |
First Address | Los Angeles, CA 90034 |
Second Address | Los Angeles, CA 90034-3710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2007 |
Last Update Date | 10/03/2017 |