Provider Demographics
NPI:1235387036
Name:BEATTY, TIFFANI JEAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANI
Middle Name:JEAN
Last Name:BEATTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TIFFANI
Other - Middle Name:JEAN
Other - Last Name:PEARSON-SPIKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCSW
Mailing Address - Street 1:1471 DEWAR DR
Mailing Address - Street 2:STE 216
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-5826
Mailing Address - Country:US
Mailing Address - Phone:307-352-6677
Mailing Address - Fax:307-352-6614
Practice Address - Street 1:1471 DEWAR DR
Practice Address - Street 2:STE 216
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5826
Practice Address - Country:US
Practice Address - Phone:307-352-6677
Practice Address - Fax:307-352-6614
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY#702101Y00000X
WYPCSW-338101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor