Provider Demographics
NPI:1912083932
Name:GILLEY, TIFFANY (LSW)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GILLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 HOWZE BEACH
Mailing Address - Street 2:SUITE B
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5356
Mailing Address - Country:US
Mailing Address - Phone:985-639-8040
Mailing Address - Fax:866-374-8776
Practice Address - Street 1:316 HOWZE BEACH
Practice Address - Street 2:SUITE B
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5356
Practice Address - Country:US
Practice Address - Phone:985-639-8040
Practice Address - Fax:866-374-8776
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2178101Y00000X, 101YA0400X, 101YM0800X, 104100000X
LA193106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist