Provider Demographics
NPI:1174404917
Name:NEAL, TIFFANY J (PHD, HSPP)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:J
Last Name:NEAL
Suffix:
Gender:F
Credentials:PHD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2805 E 10TH ST STE 170
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-2619
Mailing Address - Country:US
Mailing Address - Phone:812-856-1602
Mailing Address - Fax:812-856-1601
Practice Address - Street 1:2805 E 10TH ST STE 170
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-2619
Practice Address - Country:US
Practice Address - Phone:812-856-1602
Practice Address - Fax:812-856-1601
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20043898A103T00000X
IN000046473103TS0200X
IN20043898B103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool