Provider Demographics
NPI:1609116847
Name:WELLS-HONORE, TIFFANY (LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:WELLS-HONORE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:WELLS-HONORE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 83315
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70884-3315
Mailing Address - Country:US
Mailing Address - Phone:225-907-5750
Mailing Address - Fax:225-709-9422
Practice Address - Street 1:5329 DIJON DR
Practice Address - Street 2:STE 105
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4378
Practice Address - Country:US
Practice Address - Phone:225-907-5750
Practice Address - Fax:225-709-9422
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-25
Last Update Date:2018-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600867100Medicaid