Provider Demographics
NPI:1639684749
Name:LEMERY, TIFFANY D (LCSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:LEMERY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7335 E PALMER WASILLA HWY STE 2B
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7710
Mailing Address - Country:US
Mailing Address - Phone:907-745-6200
Mailing Address - Fax:
Practice Address - Street 1:7335 E PALMER WASILLA HWY STE 2B
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7710
Practice Address - Country:US
Practice Address - Phone:907-745-6200
Practice Address - Fax:907-745-6211
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1790731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK179073Medicaid
AK1722585Medicaid
AK1707635Medicaid