Provider Demographics
NPI:1871758862
Name:MCCLURE, TIFFANY NICHOLE (LSW)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:NICHOLE
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-0005
Mailing Address - Country:US
Mailing Address - Phone:419-250-3909
Mailing Address - Fax:
Practice Address - Street 1:312 LOCUST ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1801
Practice Address - Country:US
Practice Address - Phone:330-762-0591
Practice Address - Fax:330-762-2242
Is Sole Proprietor?:No
Enumeration Date:2008-07-19
Last Update Date:2008-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0700244104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker