MEDICARE: TIFFANY GILLEY LSW

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	101Y00000X	Counselor	2178	LA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	2178	LA
3	101YM0800X	Mental Health Counselor	2178	LA
4	104100000X	Social Worker	2178	LA
5	106H00000X	Marriage & Family Therapist	193	LA

General Provider Information

NPI Number	:	1912083932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY GILLEY LSW

Provider Business Mailing Address
First Line	:	316 HOWZE BEACH
Second Line	:	SUITE B
City	:	SLIDELL
State	:	LA
Zip	:	70461-5356
Country	:	US
Telephone Number	:	985-639-8040
Fax Number	:	866-374-8776

Provider Business Practice Location Address
First Line	:	316 HOWZE BEACH
Second Line	:	SUITE B
City	:	SLIDELL
State	:	LA
Zip	:	70461-5356
Country	:	US
Telephone Number	:	985-639-8040
Fax Number	:	866-374-8776

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	09/11/2025

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Directions to “ TIFFANY GILLEY LSW” Practice Location

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