MEDICARE: MRS. TIFFANY COLE HALL LCSW, LCADC

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
1	1041C0700X	Clinical Social Worker	KY-4890	KY

General Provider Information

NPI Number	:	1194884163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TIFFANY COLE HALL LCSW, LCADC

Provider Business Mailing Address
First Line	:	8605 CODINGTON CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40299-1012
Country	:	US
Telephone Number	:	502-592-5009
Fax Number	:	502-582-0905

Provider Business Practice Location Address
First Line	:	4710 SUNNY HILL DR
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-8406
Country	:	US
Telephone Number	:	502-592-5009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	01/20/2026

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