Basic Information
| Provider Information | |||||||||
| NPI: | 1548685613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUSEIN | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | NICOLE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 721 N PINES RD | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992065225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094263845 | ||||||||
| FaxNumber: | 5099227947 | ||||||||
| Practice Location | |||||||||
| Address1: | 721 N PINES RD | ||||||||
| Address2: | |||||||||
| City: | SPOKANE VALLEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992065225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094263845 | ||||||||
| FaxNumber: | 5099227947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2014 | ||||||||
| LastUpdateDate: | 02/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | PY60196500 | WA | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.