Provider Demographics
NPI:1508589383
Name:CLAY, TIFFANI LEILA (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANI
Middle Name:LEILA
Last Name:CLAY
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 1:7522 N GREENVIEW AVE APT 308
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1757
Mailing Address - Country:US
Mailing Address - Phone:773-332-6989
Mailing Address - Fax:
Practice Address - Street 1:7522 N GREENVIEW AVE APT 308
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626-1757
Practice Address - Country:US
Practice Address - Phone:773-332-6989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.017654101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health