Provider Demographics
NPI:1073296794
Name:HATFIELD, TIFFANY L (LCSW, LCAC-A)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:LCSW, LCAC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2040 N SHADELAND AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-1712
Mailing Address - Country:US
Mailing Address - Phone:317-355-8242
Mailing Address - Fax:
Practice Address - Street 1:2040 N SHADELAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1712
Practice Address - Country:US
Practice Address - Phone:317-355-8242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010572A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical