Provider Demographics
NPI:1558065920
Name:GIBSON, TIFFANY (ALS)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GIBSON
Suffix:
Gender:F
Credentials:ALS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 E TOWNE LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36804-3207
Mailing Address - Country:US
Mailing Address - Phone:334-524-7897
Mailing Address - Fax:
Practice Address - Street 1:903 E TOWNE LAKE CIR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36804-3207
Practice Address - Country:US
Practice Address - Phone:334-444-5869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-29
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04441101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor