Provider Demographics
NPI:1346768413
Name:GREEN, TIFFANY E (MAPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:E
Last Name:GREEN
Suffix:
Gender:F
Credentials:MAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60506-4106
Mailing Address - Country:US
Mailing Address - Phone:630-896-2337
Mailing Address - Fax:630-896-3515
Practice Address - Street 1:412 N LAKE ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-4106
Practice Address - Country:US
Practice Address - Phone:630-896-2337
Practice Address - Fax:630-896-3515
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2021-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health