Provider Demographics
NPI:1780987453
Name:LOVELACE TAYLOR, TIFFIANY (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:TIFFIANY
Middle Name:
Last Name:LOVELACE TAYLOR
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 PYRENEES DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-2921
Mailing Address - Country:US
Mailing Address - Phone:314-324-6262
Mailing Address - Fax:
Practice Address - Street 1:1875 PYRENEES DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2921
Practice Address - Country:US
Practice Address - Phone:314-324-6262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-17
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20080103111041C0700X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical