Provider Demographics
NPI:1386160679
Name:MOONEY, TIFFANY (LPC-MH, QMHP)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:MOONEY
Suffix:
Gender:F
Credentials:LPC-MH, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 W MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-8174
Mailing Address - Country:US
Mailing Address - Phone:605-721-8822
Mailing Address - Fax:
Practice Address - Street 1:2902 W MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-8174
Practice Address - Country:US
Practice Address - Phone:605-721-8822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1631101YM0800X
ND1046-12-15-19101YM0800X
SDLPC-MH20401101YM0800X
NEIMHP-2457101YM0800X
SDLPC7431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health