Provider Demographics
NPI:1730812298
Name:ELLER, TIFFANY (LGPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ELLER
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 RACE TRACK RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3310
Mailing Address - Country:US
Mailing Address - Phone:144-397-5557
Mailing Address - Fax:
Practice Address - Street 1:90 PAINTERS MILL RD STE 203
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-3614
Practice Address - Country:US
Practice Address - Phone:410-413-4108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-02
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional