Healthcare Provider Details

I. General information

NPI: 1154720597
Provider Name (Legal Business Name): TIFFANY SCOTT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 11/05/2021
Certification Date: 11/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N CHERRY ST
RUSHVILLE IN
46173-1097
US

IV. Provider business mailing address

645 S ROGERS ST
BLOOMINGTON IN
47403-2353
US

V. Phone/Fax

Practice location:
  • Phone: 765-932-3974
  • Fax: 765-932-3576
Mailing address:
  • Phone: 812-337-2221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33005443A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34009463A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: