Healthcare Provider Details

I. General information

NPI: 1548489172
Provider Name (Legal Business Name): TIFFANY JEAN MARTIN LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIFFANY MCKINNEY

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4641 FULTON DR NW
CANTON OH
44718-2384
US

IV. Provider business mailing address

4641 FULTON DR NW
CANTON OH
44718-2384
US

V. Phone/Fax

Practice location:
  • Phone: 330-433-6075
  • Fax:
Mailing address:
  • Phone: 330-433-6075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.2001896-SUPV
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2001896-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: