Provider Demographics
NPI:1154042786
Name:HINES, TIFFANY R (LMSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:R
Last Name:HINES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 ANDERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-4030
Mailing Address - Country:US
Mailing Address - Phone:785-333-3793
Mailing Address - Fax:785-390-8500
Practice Address - Street 1:1445 ANDERSON AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4030
Practice Address - Country:US
Practice Address - Phone:785-333-3793
Practice Address - Fax:785-390-8500
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12830104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker