Provider Demographics
NPI:1750056115
Name:TIFFANY, MELISSA REE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:REE
Last Name:TIFFANY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:MS
Other - First Name:MELISSA
Other - Middle Name:REE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:703 W KATELLA ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4509
Mailing Address - Country:US
Mailing Address - Phone:417-655-7131
Mailing Address - Fax:417-883-5148
Practice Address - Street 1:1636 S GLENSTONE AVE STE 100
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-1527
Practice Address - Country:US
Practice Address - Phone:417-881-1300
Practice Address - Fax:417-883-5148
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000150931101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health