Provider Demographics
NPI:1275010431
Name:HAYS, TIFFANI DAWN NICOLE (CSW)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:DAWN NICOLE
Last Name:HAYS
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 PROFESSIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1179
Mailing Address - Country:US
Mailing Address - Phone:859-744-2562
Mailing Address - Fax:859-744-0200
Practice Address - Street 1:325 PROFESSIONAL AVE
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1179
Practice Address - Country:US
Practice Address - Phone:859-744-2562
Practice Address - Fax:859-744-0020
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME253381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5165Medicaid