Provider Demographics
NPI:1982362281
Name:BARNETT, TIFFANY RENEE (CDCA, PRS)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:RENEE
Last Name:BARNETT
Suffix:
Gender:F
Credentials:CDCA, PRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1893
Mailing Address - Country:US
Mailing Address - Phone:513-356-0312
Mailing Address - Fax:
Practice Address - Street 1:4738 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-1893
Practice Address - Country:US
Practice Address - Phone:513-356-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TP2701X, 175T00000X, 251B00000X, 101YA0400X, 101YM0800X
OHCDCA.185363101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No175T00000XOther Service ProvidersPeer Specialist
No251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health