Provider Demographics
NPI:1467969824
Name:WHITE, TIFFANY ELIZABETH (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELIZABETH
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 HIGHWAY 70 E
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:71943-8735
Mailing Address - Country:US
Mailing Address - Phone:870-997-0960
Mailing Address - Fax:
Practice Address - Street 1:311 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:AMITY
Practice Address - State:AR
Practice Address - Zip Code:71921-9126
Practice Address - Country:US
Practice Address - Phone:870-997-0960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1805057101YM0800X
171M00000X
ARP2008065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator