Provider Demographics
NPI:1063163665
Name:HALL, TIFFANY D (LPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:D
Last Name:HALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 SE PRINCETON PL
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2751
Mailing Address - Country:US
Mailing Address - Phone:816-522-1820
Mailing Address - Fax:816-774-8132
Practice Address - Street 1:1321 SE PRINCETON PL
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-2751
Practice Address - Country:US
Practice Address - Phone:816-522-1820
Practice Address - Fax:816-774-8132
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2025-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025027068101YP2500X
MO2022014691101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490109127Medicaid