Healthcare Provider Details

I. General information

NPI: 1801748660
Provider Name (Legal Business Name): TIFFANY YVONNE TINKER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 W EDWARDS ST
SPRINGFIELD IL
62704-1636
US

IV. Provider business mailing address

1305 W EDWARDS ST
SPRINGFIELD IL
62704-1636
US

V. Phone/Fax

Practice location:
  • Phone: 480-588-0137
  • Fax:
Mailing address:
  • Phone: 480-588-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178021045
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: