Provider Demographics
NPI:1922650282
Name:FARMER, TIFFANY (MFT-ASSOCIATE)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:MFT-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4169 WESTPORT RD STE 103
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-2747
Mailing Address - Country:US
Mailing Address - Phone:502-333-9466
Mailing Address - Fax:
Practice Address - Street 1:4169 WESTPORT RD STE 103
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-2747
Practice Address - Country:US
Practice Address - Phone:502-333-9466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-16
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
KY168067106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty