Provider Demographics
NPI:1669562591
Name:LEEKER, TIFFANY A (LCSW)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:LEEKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:A
Other - Last Name:CREED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 S MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:KENNETT
Mailing Address - State:MO
Mailing Address - Zip Code:63857-3039
Mailing Address - Country:US
Mailing Address - Phone:573-840-0440
Mailing Address - Fax:870-324-5122
Practice Address - Street 1:103 S MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:KENNETT
Practice Address - State:MO
Practice Address - Zip Code:63857-3039
Practice Address - Country:US
Practice Address - Phone:573-840-0440
Practice Address - Fax:870-324-5122
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2362-C1041C0700X
MO20100187561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical