MEDICARE: TIFFANY R HINES LSCSW

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	1041C0700X	Clinical Social Worker	06852	KS

General Provider Information

NPI Number	:	1154042786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY R HINES LSCSW

Provider Business Mailing Address
First Line	:	104 S 4TH ST STE D2
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-6110
Country	:	US
Telephone Number	:	785-367-8106
Fax Number	:	785-706-5302

Provider Business Practice Location Address
First Line	:	104 S 4TH ST STE D2
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66502-6110
Country	:	US
Telephone Number	:	785-367-8106
Fax Number	:	785-706-5302

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

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	06/15/2026

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