Provider Demographics
NPI:1508130782
Name:RICH, TIFFANY GWEN (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GWEN
Last Name:RICH
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 1:282 W MILLS ST
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:MI
Mailing Address - Zip Code:48471-1227
Mailing Address - Country:US
Mailing Address - Phone:810-583-0329
Mailing Address - Fax:810-648-0315
Practice Address - Street 1:217 E SANILAC RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:MI
Practice Address - Zip Code:48471-1383
Practice Address - Country:US
Practice Address - Phone:810-648-0330
Practice Address - Fax:810-648-0315
Is Sole Proprietor?:No
Enumeration Date:2012-03-06
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401011940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional