Provider Demographics
NPI:1619395696
Name:INGERSOLL, TIFFANY MARIE (PCC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:MARIE
Last Name:INGERSOLL
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:15550 DURSTINE RD.
Mailing Address - City:MOUNT EATON
Mailing Address - State:OH
Mailing Address - Zip Code:44659-0265
Mailing Address - Country:US
Mailing Address - Phone:330-359-6100
Mailing Address - Fax:
Practice Address - Street 1:15550 DURSTINE RD
Practice Address - Street 2:
Practice Address - City:DUNDEE
Practice Address - State:OH
Practice Address - Zip Code:44624-9428
Practice Address - Country:US
Practice Address - Phone:330-359-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0900513101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional