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NPI Code Detail

MEDICARE: TIFFANY FANG LPC

MEDICARE: TIFFANY FANG 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
1101YP2500XProfessional Counselor178.016228IL

General Provider Information

NPI Number : 1558975367
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY FANG LPC
Provider Business Mailing Address
First Line : 3225 S PRINCETON AVE APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60616-3613
Country : US
Telephone Number : 224-392-8662
Fax Number :
Provider Business Practice Location Address
First Line : 333 N MICHIGAN AVE STE 704
Second Line :
City : CHICAGO
State : IL
Zip : 60601-3905
Country : US
Telephone Number : 312-715-8234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/31/2020
Last Update Date : 08/31/2020

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Directions to “ TIFFANY FANG LPC” Practice Location

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