Provider Demographics
NPI:1134533680
Name:PHILPOT, TIFFANY GAYLE (LHCA, CCM,)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GAYLE
Last Name:PHILPOT
Suffix:
Gender:F
Credentials:LHCA, CCM,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469851 E 1101 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-7703
Mailing Address - Country:US
Mailing Address - Phone:918-775-0250
Mailing Address - Fax:918-775-6587
Practice Address - Street 1:469851 E 1101 RD
Practice Address - Street 2:
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948-7703
Practice Address - Country:US
Practice Address - Phone:918-775-0250
Practice Address - Fax:918-775-6587
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor