Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 1041C0700X | Clinical Social Worker |
NPI | 1104453836 |
---|---|
Provider Name | Ms. Tiffany Shell Flippen |
First Address | Grants, NM 87020 |
Second Address | Grants, NM 87020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2020 |
Last Update Date | 24/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00729 | (05) | NM |