Provider Demographics
NPI:1215184882
Name:SLONE, TIFFANY M (PHD)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:M
Last Name:SLONE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPA
Mailing Address - Street 1:PO BOX 302
Mailing Address - Street 2:
Mailing Address - City:ELKHORN CITY
Mailing Address - State:KY
Mailing Address - Zip Code:41522-0302
Mailing Address - Country:US
Mailing Address - Phone:606-205-6540
Mailing Address - Fax:
Practice Address - Street 1:10057 ELKHORN CRK
Practice Address - Street 2:
Practice Address - City:ASHCAMP
Practice Address - State:KY
Practice Address - Zip Code:41512-8702
Practice Address - Country:US
Practice Address - Phone:606-754-7077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical