Provider Demographics
NPI:1538481544
Name:SMITH, TIFFANY LYNN (LCSW-BACS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW-BACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 BELVIEW RD
Mailing Address - Street 2:
Mailing Address - City:LEESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71446-2902
Mailing Address - Country:US
Mailing Address - Phone:337-238-6431
Mailing Address - Fax:337-238-7070
Practice Address - Street 1:105 BELVIEW RD
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446-2902
Practice Address - Country:US
Practice Address - Phone:337-238-6431
Practice Address - Fax:337-238-7070
Is Sole Proprietor?:No
Enumeration Date:2010-02-17
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10110104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA339791YYT6Medicare PIN