Healthcare Provider Details

I. General information

NPI: 1659223568
Provider Name (Legal Business Name): THERAPY WITH TIFFANY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1335 ARBOR GREEN TRL
O FALLON IL
62269-6787
US

IV. Provider business mailing address

12 WOLF CREEK DR STE 100
SWANSEA IL
62226-2314
US

V. Phone/Fax

Practice location:
  • Phone: 618-600-4502
  • Fax:
Mailing address:
  • Phone: 618-600-4502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY BURKE
Title or Position: MANAGER/MENTAL HEALTH THERAPIST
Credential: LCPC, LPC
Phone: 618-600-4502