Provider Demographics
NPI:1821894262
Name:SINCLAIR, TIFFANY NICOLE (LAC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:SINCLAIR
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 314
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:IN
Mailing Address - Zip Code:47862-0314
Mailing Address - Country:US
Mailing Address - Phone:812-239-3247
Mailing Address - Fax:
Practice Address - Street 1:2151 LAFAYETTE AVE STE 105
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47805-2910
Practice Address - Country:US
Practice Address - Phone:812-814-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86000454A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)