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General NPI Number Information
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NPI Number | 1821894262
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Entity Type | Individual
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Provider Name | TIFFANY NICOLE SINCLAIR LAC
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Gender | Female
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 2151 LAFAYETTE AVE STE 105
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City | TERRE HAUTE
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State | IN
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Zip | 47805-2910
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Country | US
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Telephone | 812-814-4104
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 314
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City | MONTEZUMA
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State | IN
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Zip | 47862-0314
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Country | US
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Telephone | 812-239-3247
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 86000454A
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License Number State | IN
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