MEDICARE: TIFFANY N PAULLETTE 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	180010094	IL

General Provider Information

NPI Number	:	1538433354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY N PAULLETTE LCPC

Provider Business Mailing Address
First Line	:	4058 W 115TH ST APT 112
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-4418
Country	:	US
Telephone Number	:	773-556-6322
Fax Number	:

Provider Business Practice Location Address
First Line	:	4058 W 115TH ST APT 112
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-4418
Country	:	US
Telephone Number	:	312-620-0444
Fax Number	:

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

Provider Enumeration Date	:	02/24/2012
Last Update Date	:	12/02/2025

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Directions to “ TIFFANY N PAULLETTE LCPC” Practice Location

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