Provider Demographics
NPI:1609188929
Name:SMITH, TIFFANY MARIE (MS,LPC CANDIDATE)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS,LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3131
Mailing Address - Country:US
Mailing Address - Phone:405-275-2877
Mailing Address - Fax:
Practice Address - Street 1:2508 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3131
Practice Address - Country:US
Practice Address - Phone:405-275-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional