Provider Demographics
NPI:1497209464
Name:MERCHANT, TIFFANY NICOLE (LPC-CIT)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:NICOLE
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:LPC-CIT
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:NICOLE
Other - Last Name:TURMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:571 BRAUND ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-8556
Mailing Address - Country:US
Mailing Address - Phone:608-785-7000
Mailing Address - Fax:608-785-7477
Practice Address - Street 1:571 BRAUND ST
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-8556
Practice Address - Country:US
Practice Address - Phone:608-785-7000
Practice Address - Fax:608-785-7477
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3177-226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100059241Medicaid