Provider Demographics
NPI:1790371987
Name:JONES, TIFFANY (LPC; EDD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC; EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21309 GRAY HAWK DR
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-3345
Mailing Address - Country:US
Mailing Address - Phone:773-841-4368
Mailing Address - Fax:
Practice Address - Street 1:21309 GRAY HAWK DR
Practice Address - Street 2:
Practice Address - City:MATTESON
Practice Address - State:IL
Practice Address - Zip Code:60443-3345
Practice Address - Country:US
Practice Address - Phone:773-841-4368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-12
Last Update Date:2020-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178003781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional