Provider Demographics
NPI:1831865203
Name:RODDY, TIFFANY GAUBERT (LPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:GAUBERT
Last Name:RODDY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:264 HARVEST CT
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-3990
Mailing Address - Country:US
Mailing Address - Phone:985-859-0425
Mailing Address - Fax:
Practice Address - Street 1:264 HARVEST CT
Practice Address - Street 2:
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301-3990
Practice Address - Country:US
Practice Address - Phone:985-859-0425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional