Provider Demographics
NPI:1043911324
Name:CROUCH, TIFFANY MECHELLE (RBT)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:MECHELLE
Last Name:CROUCH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-2521
Mailing Address - Country:US
Mailing Address - Phone:334-618-3302
Mailing Address - Fax:
Practice Address - Street 1:317 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-2521
Practice Address - Country:US
Practice Address - Phone:334-618-3302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALBACB895599106S00000X, 106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician