Healthcare Provider Details

I. General information

NPI: 1134036783
Provider Name (Legal Business Name): TIFFANY FAIR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3913 STRATHMORE DR
MONTGOMERY AL
36116-4615
US

IV. Provider business mailing address

3913 STRATHMORE DR
MONTGOMERY AL
36116-4615
US

V. Phone/Fax

Practice location:
  • Phone: 334-220-0243
  • Fax:
Mailing address:
  • Phone: 334-220-0243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC06088
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: