Healthcare Provider Details

I. General information

NPI: 1518408319
Provider Name (Legal Business Name): ALEXANDER TIFFANY M.A., CDCA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2017
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N PROSPECT ST
BOWLING GREEN OH
43402-1335
US

IV. Provider business mailing address

3909 WOODLEY RD
TOLEDO OH
43606-1169
US

V. Phone/Fax

Practice location:
  • Phone: 419-352-5387
  • Fax:
Mailing address:
  • Phone: 419-725-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.163614
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: