Provider Demographics
NPI:1083075006
Name:SAMUELSON, TIFFANY (LMSW, CADC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:SAMUELSON
Suffix:
Gender:F
Credentials:LMSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51103-3200
Mailing Address - Country:US
Mailing Address - Phone:712-202-0777
Mailing Address - Fax:712-234-2399
Practice Address - Street 1:1021 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51105-1436
Practice Address - Country:US
Practice Address - Phone:122-522-4777
Practice Address - Fax:712-252-5920
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0732761041C0700X
IA13042101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical