Provider Demographics
NPI:1982135331
Name:MILLS, TIFFINEY (LICENSED ADDICTION)
Entity type:Individual
Prefix:
First Name:TIFFINEY
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:LICENSED ADDICTION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 E VEROT SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3311
Mailing Address - Country:US
Mailing Address - Phone:337-345-8699
Mailing Address - Fax:337-345-8034
Practice Address - Street 1:1010 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503-2308
Practice Address - Country:US
Practice Address - Phone:337-261-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 171M00000X
LA1614101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA473998472Medicaid