Provider Demographics
NPI:1417363029
Name:HENDRICKS, TIFFANY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:TIFFANY
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1087 NW BAKER DR
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MO
Mailing Address - Zip Code:64720-2000
Mailing Address - Country:US
Mailing Address - Phone:816-803-4898
Mailing Address - Fax:
Practice Address - Street 1:1087 NW BAKER DR
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MO
Practice Address - Zip Code:64720-2000
Practice Address - Country:US
Practice Address - Phone:816-803-4898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140187241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical