Provider Demographics
NPI:1730734187
Name:SUMRALL, TIFFANY E (LMHC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:E
Last Name:SUMRALL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:HETH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:1110 CAITLIN DR SE
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-2303
Mailing Address - Country:US
Mailing Address - Phone:515-300-6563
Mailing Address - Fax:
Practice Address - Street 1:1123 1ST AVE E STE 200
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3981
Practice Address - Country:US
Practice Address - Phone:641-792-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-02
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA110038101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health