Provider Demographics
NPI:1285987784
Name:CHOUTEAU, TIFFANY M B (MS, PCC-S)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M B
Last Name:CHOUTEAU
Suffix:
Gender:F
Credentials:MS, PCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 WINDSOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4111
Mailing Address - Country:US
Mailing Address - Phone:937-409-6156
Mailing Address - Fax:937-230-3420
Practice Address - Street 1:460 WINDSOR PARK DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4111
Practice Address - Country:US
Practice Address - Phone:937-409-6156
Practice Address - Fax:937-230-3420
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0601016-SUPV101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor