Healthcare Provider Details

I. General information

NPI: 1134055767
Provider Name (Legal Business Name): TIFFANY ANDERSON PLMHP, PCMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N 48TH ST STE 303
LINCOLN NE
68504-3467
US

IV. Provider business mailing address

620 N 48TH ST STE 303
LINCOLN NE
68504-3467
US

V. Phone/Fax

Practice location:
  • Phone: 402-261-9273
  • Fax:
Mailing address:
  • Phone: 402-261-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14992
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8397
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: