Provider Demographics
NPI:1063048114
Name:GORMLEY, TIFFANY (LIMHP, LMHP, LADC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GORMLEY
Suffix:
Gender:F
Credentials:LIMHP, LMHP, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18047 OAK ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-6093
Mailing Address - Country:US
Mailing Address - Phone:402-680-4623
Mailing Address - Fax:
Practice Address - Street 1:18047 OAK ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-6093
Practice Address - Country:US
Practice Address - Phone:402-680-4623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1316101YA0400X
NE5030101YM0800X
NE2100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)