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NPI Code Detail

MEDICARE: MS. TIFFANY M STEVENS MA, LPC

MEDICARE: MS. TIFFANY M STEVENS MA, LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1114457611
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. TIFFANY M STEVENS MA, LPC
Provider Business Mailing Address
First Line : 5164 IMPERIAL DR
Second Line :
City : RICHTON PARK
State : IL
Zip : 60471-1547
Country : US
Telephone Number : 773-875-9060
Fax Number :
Provider Business Practice Location Address
First Line : 1136 S DELANO CT W STE B201
Second Line :
City : CHICAGO
State : IL
Zip : 60605-3734
Country : US
Telephone Number : 773-875-9060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2017
Last Update Date : 06/18/2019

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