Provider Demographics
NPI:1427605120
Name:FLORES, TIFFANY A (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:FLORES
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 1:10100 ELIDA RD
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9058
Mailing Address - Country:US
Mailing Address - Phone:419-695-8010
Mailing Address - Fax:419-932-6232
Practice Address - Street 1:2410 GRAPE RD STE 6
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3015
Practice Address - Country:US
Practice Address - Phone:574-217-0128
Practice Address - Fax:574-288-3447
Is Sole Proprietor?:No
Enumeration Date:2019-08-19
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007627A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN34007627AOtherLCSW LICENSE