Provider Demographics
NPI:1881346310
Name:DESMANGLES, TIFFANIE MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:TIFFANIE
Middle Name:MARIE
Last Name:DESMANGLES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 EXECUTIVE DR STE G
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4880
Mailing Address - Country:US
Mailing Address - Phone:765-237-2231
Mailing Address - Fax:
Practice Address - Street 1:25 EXECUTIVE DR STE G
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4880
Practice Address - Country:US
Practice Address - Phone:765-237-2231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34010111A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical