Provider Demographics
NPI:1457041626
Name:O'ROURKE, TIFANY LEN (LSW, CDCA)
Entity type:Individual
Prefix:
First Name:TIFANY
Middle Name:LEN
Last Name:O'ROURKE
Suffix:
Gender:F
Credentials:LSW, CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15221 STATE ROUTE 772
Mailing Address - Street 2:
Mailing Address - City:PIKETON
Mailing Address - State:OH
Mailing Address - Zip Code:45661-9062
Mailing Address - Country:US
Mailing Address - Phone:740-912-9499
Mailing Address - Fax:740-835-8692
Practice Address - Street 1:15221 STATE ROUTE 772
Practice Address - Street 2:
Practice Address - City:PIKETON
Practice Address - State:OH
Practice Address - Zip Code:45661-9062
Practice Address - Country:US
Practice Address - Phone:740-912-9499
Practice Address - Fax:740-835-8692
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.184190101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)