Provider Demographics
NPI:1992040455
Name:HARTIN, TIFFANY (LCPC-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:HARTIN
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-0461
Mailing Address - Country:US
Mailing Address - Phone:207-267-0357
Mailing Address - Fax:
Practice Address - Street 1:144 MILITARY ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2508
Practice Address - Country:US
Practice Address - Phone:207-532-9906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional