MEDICARE: TIFFANY ELLER LCPC

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	101YP2500X	Professional Counselor	LGP12694	MD

General Provider Information

NPI Number	:	1730812298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY ELLER LCPC

Provider Business Mailing Address
First Line	:	3909 NATIONAL DR
Second Line	:
City	:	BURTONSVILLE
State	:	MD
Zip	:	20866-1191
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	90 PAINTERS MILL RD STE 203
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-3614
Country	:	US
Telephone Number	:	410-413-4108
Fax Number	:

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

Provider Enumeration Date	:	07/02/2022
Last Update Date	:	04/11/2026

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