MEDICARE: TIFFANI WILES 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
1	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	5097	TN
3	101YM0800X	Mental Health Counselor	5097	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891944641
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANI WILES LPC

Provider Business Mailing Address
First Line	:	200 TECH CENTER DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37912-2747
Country	:	US
Telephone Number	:	865-637-9711
Fax Number	:

Provider Business Practice Location Address
First Line	:	3006 LAKE BROOK BLVD BLDG 1
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1137
Country	:	US
Telephone Number	:	865-544-5069
Fax Number	:

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	04/24/2024

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