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NPI Code Detail

MEDICARE: TIFFANY KELDERHOUSE MA, LPC

MEDICARE: TIFFANY KELDERHOUSE MA, 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 Counselor2365KS

General Provider Information

NPI Number : 1588983969
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY KELDERHOUSE MA, LPC
Provider Business Mailing Address
First Line : 2908 N WOODRIDGE CT
Second Line :
City : WICHITA
State : KS
Zip : 67226-6403
Country : US
Telephone Number : 316-371-3252
Fax Number :
Provider Business Practice Location Address
First Line : 6525 E MAINSGATE RD
Second Line :
City : WICHITA
State : KS
Zip : 67226-1062
Country : US
Telephone Number : 316-530-2868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2010
Last Update Date : 02/10/2023

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Directions to “ TIFFANY KELDERHOUSE MA, LPC” Practice Location

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