Provider Demographics
NPI:1285099358
Name:EVERAGE, TIFFANY MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MARIE
Last Name:EVERAGE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5304 W BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60639-4357
Mailing Address - Country:US
Mailing Address - Phone:773-556-7965
Mailing Address - Fax:
Practice Address - Street 1:1515 N HARLEM AVE
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-1250
Practice Address - Country:US
Practice Address - Phone:773-556-7965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.010198101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional