Provider Demographics
NPI:1861764342
Name:THOMAS, TIFFANY NICOLE (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:NICOLE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 WINSTON CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050
Mailing Address - Country:US
Mailing Address - Phone:636-524-3895
Mailing Address - Fax:636-931-1961
Practice Address - Street 1:508 NORTH TRUMAN BLVD
Practice Address - Street 2:UPPER LEVEL J
Practice Address - City:CRYSTAL CITY
Practice Address - State:MO
Practice Address - Zip Code:63019
Practice Address - Country:US
Practice Address - Phone:636-524-3895
Practice Address - Fax:636-931-1961
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator