Provider Demographics
NPI:1780439679
Name:CHANCELLOR, TIFFANY C (LMSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:C
Last Name:CHANCELLOR
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 1:1209 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-5413
Mailing Address - Country:US
Mailing Address - Phone:405-593-3280
Mailing Address - Fax:
Practice Address - Street 1:1209 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-5413
Practice Address - Country:US
Practice Address - Phone:405-593-3280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20628-P104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker