Healthcare Provider Details

I. General information

NPI: 1255916821
Provider Name (Legal Business Name): TIFFANIE BAILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 BAYOU ST
VINCENNES IN
47591-1034
US

IV. Provider business mailing address

PO BOX 556
VINCENNES IN
47591-0556
US

V. Phone/Fax

Practice location:
  • Phone: 812-886-6800
  • Fax: 812-886-6809
Mailing address:
  • Phone: 812-494-9501
  • Fax: 812-494-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33010134A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010395A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: