Provider Demographics
NPI:1922718857
Name:STEMPLE, TIFFANY ELLEN
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ELLEN
Last Name:STEMPLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 RAVINIA RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25314-1841
Mailing Address - Country:US
Mailing Address - Phone:304-951-7573
Mailing Address - Fax:
Practice Address - Street 1:1021 QUARRIER ST STE 310
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-2338
Practice Address - Country:US
Practice Address - Phone:304-951-7573
Practice Address - Fax:304-988-4424
Is Sole Proprietor?:No
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health