Provider Demographics
NPI:1669847760
Name:TIFTAREA PSYCHIATRIC AND COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:TIFTAREA PSYCHIATRIC AND COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:229-339-3721
Mailing Address - Street 1:PO BOX 1613
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-1613
Mailing Address - Country:US
Mailing Address - Phone:229-339-3721
Mailing Address - Fax:229-472-9151
Practice Address - Street 1:223 2ND ST E
Practice Address - Street 2:SUITE B
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-4493
Practice Address - Country:US
Practice Address - Phone:229-339-3721
Practice Address - Fax:229-472-9151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty