Provider Demographics
NPI:1972087864
Name:TIFFANY T LOVELADY COUNSELING
Entity Type:Organization
Organization Name:TIFFANY T LOVELADY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVELADY
Authorized Official - Suffix:
Authorized Official - Credentials:DPC, LPC, NCC, NCSC
Authorized Official - Phone:769-234-4153
Mailing Address - Street 1:506 PARKVIEW CV
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-7927
Mailing Address - Country:US
Mailing Address - Phone:769-234-4153
Mailing Address - Fax:833-252-6410
Practice Address - Street 1:357 TOWNE CENTER PL STE 400
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4844
Practice Address - Country:US
Practice Address - Phone:888-561-3380
Practice Address - Fax:833-252-6410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09175888Medicaid