Provider Demographics
NPI:1639476476
Name:SMITH, TIFFANY NYCOLE (LPC)
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:NYCOLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 S TRINITY ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-1819
Mailing Address - Country:US
Mailing Address - Phone:940-627-1630
Mailing Address - Fax:940-626-3741
Practice Address - Street 1:101 S TRINITY ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-1819
Practice Address - Country:US
Practice Address - Phone:940-627-1630
Practice Address - Fax:940-626-3741
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17033101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional