Provider Demographics
NPI:1134568082
Name:PEERY, TIFFANY M (LPCC-S)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:M
Last Name:PEERY
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:MATHIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 W RIVER RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44280-9573
Mailing Address - Country:US
Mailing Address - Phone:315-281-5870
Mailing Address - Fax:
Practice Address - Street 1:1865 N RIDGE RD E STE D
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44055-3359
Practice Address - Country:US
Practice Address - Phone:440-723-5486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1600004-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health