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General NPI Number Information
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NPI Number | 1750544102
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Entity Type | Organization
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Legal Business Name | TIFFANY L. CORJAY, INC.
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Dates
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Enumeration Date | 07/07/2008
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Last Update Date | 05/27/2014
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Provider Practice Location Address
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Address Line | 1603 CENTRAL AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-6117
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Country | US
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Telephone | 501-627-2555
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Fax | 501-321-2884
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Provider Business Mailing Address
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Address Line | 1603 CENTRAL AVE
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City | HOT SPRINGS
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State | AR
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Zip | 71901-6117
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Country | US
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Telephone | 501-627-2555
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Fax | 501-321-2884
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. TIFFANY L. CORJAY
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Credential | LCSW
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Telephone | 501-627-2555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1813-C
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License Number State | AR
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