Healthcare Provider Details

I. General information

NPI: 1154042786
Provider Name (Legal Business Name): TIFFANY R HINES LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 S 4TH ST STE D2
MANHATTAN KS
66502-6110
US

IV. Provider business mailing address

104 S 4TH ST STE D2
MANHATTAN KS
66502-6110
US

V. Phone/Fax

Practice location:
  • Phone: 785-367-8106
  • Fax: 785-706-5302
Mailing address:
  • Phone: 785-367-8106
  • Fax: 785-706-5302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06852
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: