Provider Demographics
NPI:1437571759
Name:TIFFANY WELLS, LLC
Entity Type:Organization
Organization Name:TIFFANY WELLS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:225-907-5750
Mailing Address - Street 1:6212 STUMBERG LN
Mailing Address - Street 2:UNIT 405
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6313
Mailing Address - Country:US
Mailing Address - Phone:225-907-5750
Mailing Address - Fax:225-709-3422
Practice Address - Street 1:5329 DIJON DR
Practice Address - Street 2:STE 105
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4378
Practice Address - Country:US
Practice Address - Phone:225-907-5750
Practice Address - Fax:225-709-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty