Provider Demographics
NPI:1457019846
Name:CARPENTER, TIFFANY (LPC-A)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-5715
Mailing Address - Country:US
Mailing Address - Phone:903-593-9141
Mailing Address - Fax:903-593-9865
Practice Address - Street 1:218 N COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-5715
Practice Address - Country:US
Practice Address - Phone:903-593-9141
Practice Address - Fax:903-593-9865
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor