Provider Demographics
NPI:1790978377
Name:GORSUCH BAINTER, TIFFANY ERIN (PHD, LCPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:ERIN
Last Name:GORSUCH BAINTER
Suffix:
Gender:F
Credentials:PHD, LCPC, NCC
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:BAINTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD LCPC NCC
Mailing Address - Street 1:1 UNIVERSITY CIR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-1367
Mailing Address - Country:US
Mailing Address - Phone:309-298-1919
Mailing Address - Fax:
Practice Address - Street 1:1 UNIVERSITY CIR
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-1367
Practice Address - Country:US
Practice Address - Phone:309-298-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health