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General NPI Number Information
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NPI Number | 1467969824
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Entity Type | Individual
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Provider Name | TIFFANY ELIZABETH WHITE LPC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2018
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Last Update Date | 05/28/2021
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Provider Practice Location Address
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Address Line | 311 NORTH MAIN STREET
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City | AMITY
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State | AR
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Zip | 71921-9126
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Country | US
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Telephone | 870-997-0960
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 HIGHWAY 70 E
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City | GLENWOOD
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State | AR
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Zip | 71943-8735
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Country | US
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Telephone | 870-997-0960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | A1805057
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2008065
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License Number State | AR
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