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NPI Code Detail

MEDICARE: TIFFANY REYNOLDS

MEDICARE: TIFFANY REYNOLDS
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1679428866
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY REYNOLDS
Provider Business Mailing Address
First Line : 218 E NORTH ST
Second Line :
City : WAVERLY
State : OH
Zip : 45690-1148
Country : US
Telephone Number : 740-947-6727
Fax Number :
Provider Business Practice Location Address
First Line : 218 E NORTH ST
Second Line :
City : WAVERLY
State : OH
Zip : 45690-1148
Country : US
Telephone Number : 740-947-6727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/03/2026
Last Update Date : 03/03/2026

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1679711386 — PAMELA JOHNSON M.ED.,PCC-S
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Directions to “ TIFFANY REYNOLDS ” Practice Location

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