Provider Demographics
NPI:1467112417
Name:SHURTZ, TIFFANY NICOLE (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:SHURTZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-1633
Mailing Address - Fax:618-724-4628
Practice Address - Street 1:119 GAS PLANT RD
Practice Address - Street 2:
Practice Address - City:DU QUIN
Practice Address - State:IL
Practice Address - Zip Code:62832-3866
Practice Address - Country:US
Practice Address - Phone:618-790-2146
Practice Address - Fax:618-790-2147
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490238771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical