Provider Demographics
NPI:1033690102
Name:ZACHERY, TIFFANY SHARELL (LCSW, PHD)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:SHARELL
Last Name:ZACHERY
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62506
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-2506
Mailing Address - Country:US
Mailing Address - Phone:337-290-9868
Mailing Address - Fax:
Practice Address - Street 1:110 TRAVIS ST STE 113
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2453
Practice Address - Country:US
Practice Address - Phone:225-614-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2019-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA113371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1033690102Medicaid