Provider Demographics
NPI:1720680853
Name:RALEY, TIFFANY BROOKE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:BROOKE
Last Name:RALEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:TIFFANY
Other - Middle Name:BROOKE
Other - Last Name:RANKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:925 KEENAN LN
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:WI
Mailing Address - Zip Code:53589-1015
Mailing Address - Country:US
Mailing Address - Phone:608-609-4766
Mailing Address - Fax:
Practice Address - Street 1:4868 HIGH CROSSING BLVD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-7403
Practice Address - Country:US
Practice Address - Phone:608-274-8294
Practice Address - Fax:608-274-8783
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7939-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional