Provider Demographics
NPI:1396520490
Name:JOLLY, TIFFANY M (LMSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:JOLLY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9052 BOSTON SPRINGS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-0409
Mailing Address - Country:US
Mailing Address - Phone:725-285-5973
Mailing Address - Fax:
Practice Address - Street 1:9052 BOSTON SPRINGS AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-0409
Practice Address - Country:US
Practice Address - Phone:725-285-5973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical