Provider Demographics
NPI:1881345577
Name:ELSON, TIFFANY RENEE (MA, LPC, CDCA)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENEE
Last Name:ELSON
Suffix:
Gender:F
Credentials:MA, LPC, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ELMWOOD PARK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-5402
Mailing Address - Country:US
Mailing Address - Phone:937-384-0580
Mailing Address - Fax:
Practice Address - Street 1:100 ELMWOOD PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45449-5402
Practice Address - Country:US
Practice Address - Phone:937-384-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-13
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2203810-TRNE101Y00000X
OHCDCA.183164101YA0400X
OHC2304896101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1881345577Medicaid