MEDICARE: MRS. TIFFANY M PEERY LPCC-S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	E.1600004-SUPV	OH

General Provider Information

NPI Number	:	1134568082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY M PEERY LPCC-S

Provider Business Mailing Address
First Line	:	196 W RIVER RD
Second Line	:
City	:	VALLEY CITY
State	:	OH
Zip	:	44280-9573
Country	:	US
Telephone Number	:	315-281-5870
Fax Number	:

Provider Business Practice Location Address
First Line	:	1865 N RIDGE RD E STE D
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-3359
Country	:	US
Telephone Number	:	440-723-5486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2013
Last Update Date	:	12/11/2019

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