Provider Demographics
NPI:1083131106
Name:WORLEY, TIFFANY ANN
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ANN
Last Name:WORLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3878 BAINBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-5979
Mailing Address - Country:US
Mailing Address - Phone:440-241-7750
Mailing Address - Fax:
Practice Address - Street 1:6785 WALLINGS RD
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-3024
Practice Address - Country:US
Practice Address - Phone:440-457-7474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.2303341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health