MEDICARE: TIFFANY ROYSTER LCPC

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	101YP2500X	Professional Counselor	LC2250	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11829265	OTHER	MD	CAQH

General Provider Information

NPI Number	:	1326211202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY ROYSTER LCPC

Provider Business Mailing Address
First Line	:	7100 BEISSEL CT
Second Line	:
City	:	BRANDYWINE
State	:	MD
Zip	:	20613-6221
Country	:	US
Telephone Number	:	301-775-3765
Fax Number	:	301-248-4338

Provider Business Practice Location Address
First Line	:	4400 STAMP RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6716
Country	:	US
Telephone Number	:	301-775-3765
Fax Number	:	301-248-4338

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

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	04/10/2008

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Directions to “ TIFFANY ROYSTER LCPC” Practice Location

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