Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 156F00000X | Technician/Technologist |
NPI | 1073006813 |
---|---|
Provider Name | Tiffany Jeffers |
First Address | Bingham Farms, MI 48025-2454 |
Second Address | Clinton Township, MI 48035-2206 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2018 |
Last Update Date | 11/10/2021 |