Provider Demographics
NPI:1376187591
Name:YOUNG, TIFFANI M (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1616
Mailing Address - Country:US
Mailing Address - Phone:484-860-0069
Mailing Address - Fax:
Practice Address - Street 1:576 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1616
Practice Address - Country:US
Practice Address - Phone:484-860-0069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PABH004604103K00000X
PAPC016289101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst