Provider Demographics
NPI:1255715066
Name:GRAVELEY, TIFFANY (LMHC, LPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:GRAVELEY
Suffix:
Gender:F
Credentials:LMHC, LPC
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC, LPC
Mailing Address - Street 1:13 PEGGY ANN RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-9085
Mailing Address - Country:US
Mailing Address - Phone:845-494-2914
Mailing Address - Fax:
Practice Address - Street 1:13 PEGGY ANN RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-9085
Practice Address - Country:US
Practice Address - Phone:845-494-2914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC13085101YM0800X
NY006472-1101YM0800X
VA0701011909101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional