Provider Demographics
NPI:1578894960
Name:TIFFANY, KATHY RUTH (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:RUTH
Last Name:TIFFANY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 PAPAGO DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5814
Mailing Address - Country:US
Mailing Address - Phone:307-674-7558
Mailing Address - Fax:
Practice Address - Street 1:45 E LOUCKS ST STE 45
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6339
Practice Address - Country:US
Practice Address - Phone:307-675-8105
Practice Address - Fax:307-675-8105
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health