MEDICARE: TIFFANY SMITH BCBA

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	103K00000X	Behavior Analyst	1-25-85613	TN

General Provider Information

NPI Number	:	1205513520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY SMITH BCBA

Provider Business Mailing Address
First Line	:	376 ROCK SPRINGS RD
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37663-3029
Country	:	US
Telephone Number	:	864-641-8275
Fax Number	:

Provider Business Practice Location Address
First Line	:	2004 AMERICAN WAY STE 109
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-5892
Country	:	US
Telephone Number	:	864-641-8275
Fax Number	:

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

Provider Enumeration Date	:	06/28/2023
Last Update Date	:	11/10/2025

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Directions to “ TIFFANY SMITH BCBA” Practice Location

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