Tiffany Renee' Ellis

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

1120 3Rd St
South Lake Tahoe, CA 96150-3451

Phone

(530) 573-3386

Fax

(530) 543-6697

NPI assigned

Oct 17, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192579200000",
    "number": "1699964585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 3RD ST",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961503451",
            "telephone_number": "530-573-3386",
            "fax_number": "530-543-6697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 3RD ST",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961503451",
            "telephone_number": "530-573-3386",
            "fax_number": "530-543-6697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIS",
        "first_name": "TIFFANY",
        "middle_name": "RENEE'",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-17",
        "last_updated": "2007-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• El Dorado County Mental Health
• El Dorado County Mental Health
• El Dorado County Probation Department
• Elevate Wellness and Acupuncture Center
• Elevated Fitness LLC
• Emerald Bay Center for Women'S Health, Inc.
• Emerald Bay Physical Therapy PC
• Lars Douglas Ensign, MD
• Kyle Erkkila, PA-C
• Pollyanne Ertis, RDN

• Addiction (Substance Use Disorder) Counselor in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.