Provider Demographics
NPI:1871320416
Name:HAVLIN, TIFFANY SUE (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:SUE
Last Name:HAVLIN
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3325 E AMIDON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3528
Mailing Address - Country:US
Mailing Address - Phone:417-848-9395
Mailing Address - Fax:
Practice Address - Street 1:3325 E AMIDON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3528
Practice Address - Country:US
Practice Address - Phone:417-848-9395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20120420431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical