Provider Demographics
NPI:1508435934
Name:KEITH, TIFFANY LASHAWN (MAFT ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LASHAWN
Last Name:KEITH
Suffix:
Gender:F
Credentials:MAFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 KEWANNA DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-4805
Mailing Address - Country:US
Mailing Address - Phone:812-920-0194
Mailing Address - Fax:
Practice Address - Street 1:102 DAVENTRY LN STE 5
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2869
Practice Address - Country:US
Practice Address - Phone:502-817-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270845106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist