Provider Demographics
NPI:1225662091
Name:REAM, TIFFANY LEE (LCPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LEE
Last Name:REAM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HIGH POINT DR
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-8809
Mailing Address - Country:US
Mailing Address - Phone:937-206-3829
Mailing Address - Fax:
Practice Address - Street 1:302 HIGH POINT DR
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-8809
Practice Address - Country:US
Practice Address - Phone:937-206-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178006094101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional