Individual
TIFFANY BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1487 W KEISER AVE STE 1, OSCEOLA, AR 72370-2806
(870) 563-4500
(870) 563-4501
Mailing address
2809 FOREST HOME RD, JONESBORO, AR 72401-5320
(866) 972-1268
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
854-M
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
170696795
—
AR
Enumeration date
10/27/2016
Last updated
02/10/2023
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